Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT)

Carol Anne Graham; Mary K. Tan; Derek P. Chew; Christopher P. Gale; Keith A.A. Fox; Akshay Bagai; Mark A. Henderson; Ata ur Rehman Quraishi; Jean Pierre Déry; Asim N. Cheema; Harold Fisher; David Brieger; Sohrab R. Lutchmedial; Shahar Lavi; Brian Y.L. Wong; Tomas Cieza; Shamir R. Mehta; Neil Brass; Shaun G. Goodman; Andrew T. Yan

doi:10.1007/s00380-022-02029-8

Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT)

Carol Anne Graham, Mary K. Tan, Derek P. Chew, Christopher P. Gale, Keith A.A. Fox, Akshay Bagai, Mark A. Henderson, Ata ur Rehman Quraishi, Jean Pierre Déry, Asim N. Cheema, Harold Fisher, David Brieger, Sohrab R. Lutchmedial, Shahar Lavi, Brian Y.L. Wong, Tomas Cieza, Shamir R. Mehta, Neil Brass, Shaun G. Goodman, Andrew T. Yan

Medicine

Résultat de recherche: Article › examen par les pairs

5 Citations (Scopus)

Résumé

Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m², calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y₁₂ inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y₁₂ inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.

Langue d'origine	English
Journal	Heart and Vessels
DOI	https://doi.org/10.1007/s00380-022-02029-8
Statut de publication	Accepted/In press - 2022

Note bibliographique

Funding Information:
Carol Anne Graham, no disclosures. Mary K. Tan, no disclosures. Derek P. Chew has received speaker/consulting honoraria and/or research grant support from AstraZeneca. Christopher P. Gale, no disclosures. Keith A. Fox has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Janssen, Regeneron, Verson and Sanofi. Akshay Bagai has received speaker/consulting honoraria and/or research grant support from Abbott Vascular, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, HLS therapeutics, Servier. Mark A. Henderson, no disclosures. Ata ur Rehman Quraishi, no disclosures. Jean-Pierre Dery, no disclosures. Asim N. Cheema, no disclosures. Harold Fisher has received medical officer/salary support from Eli Lilly. David Breiger, no disclosures. Sohrab Lutchmedial, no disclosures. Shahar Lavi, no disclosures. Brian Y. Wong, no disclosures. Tomas Cieza has received speaker/consulting honoraria and/or research grant support from AstraZeneca and Eli Lilly. Shamir R. Mehta has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Boston Scientific, Eli Lilly and Sanofi. Neil Brass, no disclosures. Shaun G. Goodman has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, JAMP Pharma, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharma. Andrew T. Yan, research grant support and/or speaking consulting honoraria from AstraZeneca. Acknowledgements

Funding Information:
The COAPT study was sponsored by Eli Lilly and Daiichi Sankyo.

Publisher Copyright:
© 2022, Springer Japan KK, part of Springer Nature.

ASJC Scopus Subject Areas

Cardiology and Cardiovascular Medicine

PubMed: MeSH publication types

Journal Article

Accès au document

10.1007/s00380-022-02029-8

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Graham, C. A., Tan, M. K., Chew, D. P., Gale, C. P., Fox, K. A. A., Bagai, A., Henderson, M. A., Quraishi, A. U. R., Déry, J. P., Cheema, A. N., Fisher, H., Brieger, D., Lutchmedial, S. R., Lavi, S., Wong, B. Y. L., Cieza, T., Mehta, S. R., Brass, N., Goodman, S. G., & Yan, A. T. (Accepter/ En production). Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT). Heart and Vessels. https://doi.org/10.1007/s00380-022-02029-8

Graham, CA, Tan, MK, Chew, DP, Gale, CP, Fox, KAA, Bagai, A, Henderson, MA, Quraishi, AUR, Déry, JP, Cheema, AN, Fisher, H, Brieger, D, Lutchmedial, SR, Lavi, S, Wong, BYL, Cieza, T, Mehta, SR, Brass, N, Goodman, SG & Yan, AT 2022, 'Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT)', Heart and Vessels. https://doi.org/10.1007/s00380-022-02029-8

@article{93c29e874b334c44aa6f95bde3e1bc7b,

title = "Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease: insights from the Canadian Observational Antiplatelet Study (COAPT)",

abstract = "Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.",

author = "Graham, {Carol Anne} and Tan, {Mary K.} and Chew, {Derek P.} and Gale, {Christopher P.} and Fox, {Keith A.A.} and Akshay Bagai and Henderson, {Mark A.} and Quraishi, {Ata ur Rehman} and D{\'e}ry, {Jean Pierre} and Cheema, {Asim N.} and Harold Fisher and David Brieger and Lutchmedial, {Sohrab R.} and Shahar Lavi and Wong, {Brian Y.L.} and Tomas Cieza and Mehta, {Shamir R.} and Neil Brass and Goodman, {Shaun G.} and Yan, {Andrew T.}",

note = "Funding Information: Carol Anne Graham, no disclosures. Mary K. Tan, no disclosures. Derek P. Chew has received speaker/consulting honoraria and/or research grant support from AstraZeneca. Christopher P. Gale, no disclosures. Keith A. Fox has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Janssen, Regeneron, Verson and Sanofi. Akshay Bagai has received speaker/consulting honoraria and/or research grant support from Abbott Vascular, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, HLS therapeutics, Servier. Mark A. Henderson, no disclosures. Ata ur Rehman Quraishi, no disclosures. Jean-Pierre Dery, no disclosures. Asim N. Cheema, no disclosures. Harold Fisher has received medical officer/salary support from Eli Lilly. David Breiger, no disclosures. Sohrab Lutchmedial, no disclosures. Shahar Lavi, no disclosures. Brian Y. Wong, no disclosures. Tomas Cieza has received speaker/consulting honoraria and/or research grant support from AstraZeneca and Eli Lilly. Shamir R. Mehta has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Boston Scientific, Eli Lilly and Sanofi. Neil Brass, no disclosures. Shaun G. Goodman has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, JAMP Pharma, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharma. Andrew T. Yan, research grant support and/or speaking consulting honoraria from AstraZeneca. Acknowledgements Funding Information: The COAPT study was sponsored by Eli Lilly and Daiichi Sankyo. Publisher Copyright: {\textcopyright} 2022, Springer Japan KK, part of Springer Nature.",

year = "2022",

doi = "10.1007/s00380-022-02029-8",

language = "English",

journal = "Heart and Vessels",

issn = "0910-8327",

publisher = "Springer Japan",

}

TY - JOUR

T1 - Use and outcomes of dual antiplatelet therapy for acute coronary syndrome in patients with chronic kidney disease

T2 - insights from the Canadian Observational Antiplatelet Study (COAPT)

AU - Graham, Carol Anne

AU - Tan, Mary K.

AU - Chew, Derek P.

AU - Gale, Christopher P.

AU - Fox, Keith A.A.

AU - Bagai, Akshay

AU - Henderson, Mark A.

AU - Quraishi, Ata ur Rehman

AU - Déry, Jean Pierre

AU - Cheema, Asim N.

AU - Fisher, Harold

AU - Brieger, David

AU - Lutchmedial, Sohrab R.

AU - Lavi, Shahar

AU - Wong, Brian Y.L.

AU - Cieza, Tomas

AU - Mehta, Shamir R.

AU - Brass, Neil

AU - Goodman, Shaun G.

AU - Yan, Andrew T.

N1 - Funding Information: Carol Anne Graham, no disclosures. Mary K. Tan, no disclosures. Derek P. Chew has received speaker/consulting honoraria and/or research grant support from AstraZeneca. Christopher P. Gale, no disclosures. Keith A. Fox has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Bayer, Janssen, Regeneron, Verson and Sanofi. Akshay Bagai has received speaker/consulting honoraria and/or research grant support from Abbott Vascular, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb/Pfizer, HLS therapeutics, Servier. Mark A. Henderson, no disclosures. Ata ur Rehman Quraishi, no disclosures. Jean-Pierre Dery, no disclosures. Asim N. Cheema, no disclosures. Harold Fisher has received medical officer/salary support from Eli Lilly. David Breiger, no disclosures. Sohrab Lutchmedial, no disclosures. Shahar Lavi, no disclosures. Brian Y. Wong, no disclosures. Tomas Cieza has received speaker/consulting honoraria and/or research grant support from AstraZeneca and Eli Lilly. Shamir R. Mehta has received speaker/consulting honoraria and/or research grant support from AstraZeneca, Boston Scientific, Eli Lilly and Sanofi. Neil Brass, no disclosures. Shaun G. Goodman has received speaker/consulting honoraria and/or research grant support from Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, CSL Behring, Daiichi Sankyo/American Regent, Eli Lilly, Esperion, Ferring Pharmaceuticals, GlaxoSmithKline, HLS Therapeutics, JAMP Pharma, Janssen/Johnson & Johnson, Merck, Novartis, Novo Nordisk A/C, Pendopharm, Pfizer, Regeneron, Sanofi, Servier, Valeo Pharma. Andrew T. Yan, research grant support and/or speaking consulting honoraria from AstraZeneca. Acknowledgements Funding Information: The COAPT study was sponsored by Eli Lilly and Daiichi Sankyo. Publisher Copyright: © 2022, Springer Japan KK, part of Springer Nature.

PY - 2022

Y1 - 2022

N2 - Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.

AB - Chronic kidney disease (CKD) increases the risk of adverse outcomes in acute coronary syndrome (ACS). The optimal regimen of dual antiplatelet therapy (DAPT) post-percutaneous coronary intervention (PCI) in CKD poses a challenge due to the increased bleeding and clotting tendencies, particularly since patients with CKD were underrepresented in randomized controlled trials. We examined the practice patterns of DAPT prescription stratified by the presence of CKD. The multicentre prospective Canadian Observational Antiplatelet Study (COAPT) enrolled patients with ACS between December 2011 and May 2013. The present study is a subgroup analysis comparing type and duration of DAPT and associated outcomes among patients with and without CKD (eGFR < 60 ml/min/1.73 m2, calculated by CKD-EPI). Patients with CKD (275/1921, 14.3%) were prescribed prasugrel/ticagrelor less (18.5% vs 25.8%, p = 0.01) and had a shorter duration of DAPT therapy versus patients without CKD (median 382 vs 402 days, p = 0.003). CKD was associated with major adverse cardiovascular events (MACE) at 12 months (p < 0.001) but not bleeding when compared to patients without CKD. CKD was associated with MACE in both patients on prasugrel/ticagrelor (p = 0.017) and those on clopidogrel (p < 0.001) (p for heterogeneity = 0.70). CKD was associated with increased bleeding only among patients receiving prasugrel/ticagrelor (p = 0.007), but not among those receiving clopidogrel (p = 0.64) (p for heterogeneity = 0.036). Patients with CKD had a shorter DAPT duration and were less frequently prescribed potent P2Y12 inhibitors than patients without CKD. Overall, compared with patients without CKD, patients with CKD had higher rates of MACE and similar bleeding rates. However, among those prescribed more potent P2Y12 inhibitors, CKD was associated with more bleeding than those without CKD. Further studies are needed to better define the benefit/risk evaluation, and establish a more tailored and evidence-based DAPT regimen for this high-risk patient group.

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