PT  - JOURNAL ARTICLE
AU  - Omar K Siddiqi
AU  - Kyle J Smoot
AU  - Alyssa B Dufour
AU  - Kelly Cho
AU  - Melissa Young
AU  - David R Gagnon
AU  - Samantha Ly
AU  - Sara Temiyasathit
AU  - David P Faxon
AU  - J Michael Gaziano
AU  - Scott Kinlay
TI  - Outcomes with prolonged clopidogrel therapy after coronary stenting in patients with chronic kidney disease
AID  - 10.1136/heartjnl-2014-307168
DP  - 2015 Oct 01
TA  - Heart
PG  - 1569--1576
VI  - 101
IP  - 19
4099  - http://heart.bmj.com/content/101/19/1569.short
4100  - http://heart.bmj.com/content/101/19/1569.full
SO  - Heart2015 Oct 01; 101
AB  - Objectives Patients with chronic kidney disease (CKD) are at high risk of death or myocardial infarction (MI) after percutaneous coronary interventions (PCI). We assessed whether prolonged dual antiplatelet therapy beyond the recommended 12 months may prevent adverse outcomes in patients with CKD receiving drug-eluting stents (DES) or bare-metal stents (BMS).Methods We studied all Veterans receiving PCI with BMS or first-generation DES in the Veterans Affairs (VA) Healthcare System between 2002 and 2006, classified by CKD (estimated glomerular filtration rate <60 mL/min) or normal renal function. We used landmark analyses from 12 months after PCI with Cox proportional hazards multivariable and propensity-adjusted models to assess the effect of prolonged clopidogrel (more than 12 months) versus 12 months or less after PCI on clinical outcomes from 1 year to 4 years after PCI.Results Of 23 042 eligible subjects receiving PCI, 4880 (21%) had CKD. Compared with normal renal function, patients with CKD had higher risks of death or MI 1–4 years after DES (21% vs 12%, HR=1.75; 95% CI 1.51 to 2.04) or BMS (28% vs 15%, HR=2.10; 95% CI 1.90 to 2.32). In patients with CKD receiving DES, clopidogrel use of more than 12 months after PCI was associated with lower risks of death or MI (18% vs 24%, HR=0.74; 95% CI 0.58 to 0.95), and death (15% vs 23%, HR=0.61; 95% CI 0.47 to 0.80), but had no effect on repeat revascularisation 1–4 years after PCI.Conclusions In patients with CKD, prolonging clopidogrel beyond 12 months after PCI may decrease the risk of death or MI only in patients receiving first-generation DES. These results support a patient-tailored approach to prolonging clopidogrel after PCI.