Impact of Clopidogrel Loading Dose in Patients With Chronic Kidney Disease Undergoing Primary Percutaneous Coronary Intervention for ST-Segment Elevation Myocardial Infarction

Authors
Joon Young KimMyung Ho JeongJae Hyun MoonYong Keun AhnShung Chull ChaeSeung Ho HurTaek Jong HongYoung Jo KimIn Whan SeongIn Ho ChaeMyeong Chan ChoYang Soo JangJung Han YoonKi Bae SeungSeung Jung Park
Department
Dept. of Internal Medicine (내과학)
Issue Date
2012
Citation
American Journal of Cardiology, Vol.110(11) : 1598-1606, 2012
ISSN
0002-9149
Abstract
The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m2) were evaluated according to clopidogrel loading dose: 600 mg (n 861) versus 300 mg (n 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8% vs 0.2%, p 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6% vs 16.4%, p 0.70) and 12 months (19.0% vs 21.3%, p 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95% confidence interval 0.49 to 2.57, p 0.78) and 12-month (odds ratio 0.89, 95% confidence interval 0.52 to 1.51, p 0.66) major adverse cardiac events. After propensity score–matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate. © 2012 Elsevier Inc. All rights reserved. (Am J Cardiol 2012;110:1598 –1606)
URI
http://kumel.medlib.dsmc.or.kr/handle/2015.oak/34891
Appears in Collections:
1. Journal Papers (연구논문) > 1. School of Medicine (의과대학) > Dept. of Internal Medicine (내과학)
Keimyung Author(s)
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Full Text
https://linkinghub.elsevier.com/retrieve/pii/S0002914912018462
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