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Introduction <p>Chronic kidney disease (CKD) is a well-documented risk factor for major adverse cardiac events and bleeding events. The optimal antiplatelet strategy for patients with CKD remains unclear, especially patients with glomerular filtration rate (GFR) &lt; 30&#xa0;ml/min. We aim to compare clinical outcomes of patients with acute coronary syndrome (ACS) and CKD treated with ticagrelor or prasugrel vs. clopidogrel.</p> Methods <p>Patients were collected from the acute coronary syndrome Israeli survey (ACSIS). Patients were divided into 2 groups: ST-segment myocardial infarction (STEMI) and non-STEMI. Each group was further divided based on the GFR value (&lt;30&#xa0;ml/min or ≥ 30&#xa0;ml/min). Mortality, bleeding, repeat revascularization, and re-hospitalization at 30-day and 1-year were evaluated.</p> Results <p>A total of 5,442 patients were included in the final analysis. There were no significant differences regarding baseline characteristics between both groups of ACS patients. In patients with STEMI and GFR &lt; 30&#xa0;ml/min, re-hospitalization (32% vs. 29 % p = 1.0), bleeding (2.7% vs 2.3% p = 0.9), and death rates (8.1 % vs 2.3% p = 0.5) did not differ between the two different treatment strategies at 30-day follow-up. The mortality rate in 1-year was lower among STEMI patients treated with the ticagrelor or prasugrel as compared with clopidogrel (33% vs 11% p = 0.04).</p> Conclusion <p>In patients with ACS and CKD, rehospitalization, bleeding and mortality rates were similar in30 days in patients treated with ticagrelor/prasugrel versus clopidogrel. Nevertheless, in patients presenting with STEMI and GFR &lt; 30&#xa0;ml/min, treatment with ticagrelor/prasugrel was correlated with a lower 1-year mortality rate as compared with clopidogrel treatment with no increase in bleeding rates.</p>

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Optimal antiplatelet therapy in patients with acute coronary syndrome and chronic kidney disease: for the Jerusalem platelets thrombosis and intervention in cardiology (JUPITER-11) study group

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年8月4日

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  • Perel Nimrod,
  • Marmor David,
  • Taha Louay,
  • Tabi Meir,
  • Itshak Amsalem,
  • Rafi Hitter,
  • Tomer Maller,
  • Nir Levy,
  • Lior Lupu,
  • Hezzy Shmueli,
  • Sharon Bruoha,
  • Tal Ovdat,
  • Michael Glikson,
  • Elad Asher

摘要

Introduction

Chronic kidney disease (CKD) is a well-documented risk factor for major adverse cardiac events and bleeding events. The optimal antiplatelet strategy for patients with CKD remains unclear, especially patients with glomerular filtration rate (GFR) < 30 ml/min. We aim to compare clinical outcomes of patients with acute coronary syndrome (ACS) and CKD treated with ticagrelor or prasugrel vs. clopidogrel.

Methods

Patients were collected from the acute coronary syndrome Israeli survey (ACSIS). Patients were divided into 2 groups: ST-segment myocardial infarction (STEMI) and non-STEMI. Each group was further divided based on the GFR value (<30 ml/min or ≥ 30 ml/min). Mortality, bleeding, repeat revascularization, and re-hospitalization at 30-day and 1-year were evaluated.

Results

A total of 5,442 patients were included in the final analysis. There were no significant differences regarding baseline characteristics between both groups of ACS patients. In patients with STEMI and GFR < 30 ml/min, re-hospitalization (32% vs. 29 % p = 1.0), bleeding (2.7% vs 2.3% p = 0.9), and death rates (8.1 % vs 2.3% p = 0.5) did not differ between the two different treatment strategies at 30-day follow-up. The mortality rate in 1-year was lower among STEMI patients treated with the ticagrelor or prasugrel as compared with clopidogrel (33% vs 11% p = 0.04).

Conclusion

In patients with ACS and CKD, rehospitalization, bleeding and mortality rates were similar in30 days in patients treated with ticagrelor/prasugrel versus clopidogrel. Nevertheless, in patients presenting with STEMI and GFR < 30 ml/min, treatment with ticagrelor/prasugrel was correlated with a lower 1-year mortality rate as compared with clopidogrel treatment with no increase in bleeding rates.