Table_1_Ticagrelor vs. Clopidogrel in Acute Coronary Syndrome Patients With Chronic Kidney Disease After New-Generation Drug-Eluting Stent Implantation.DOCX

Background: The impact of ticagrelor-based dual antiplatelet therapy (DAPT) on acute coronary syndrome (ACS) in patients with chronic kidney disease (CKD) remains unclear.
Methods: Data on a total of 1,067 ACS patients with CKD including end-stage renal disease (ESRD) who underwent new-generation drug-eluting stent implantation were extracted from a multicenter registry. This study aimed to compare outcomes of patients treated with ticagrelor- (n = 449) and those treated with clopidogrel-based (n = 618) DAPT. Outcomes of interest included major adverse cardiac and cerebrovascular events (MACCEs) and bleeding (Bleeding Academic Research Consortium grade 3 or 5) at 12 months. Propensity-score matching (346 pairs) analysis was performed.
Results: The patients with ESRD showed the highest MACCE and bleeding rates (P < 0.001). There was no difference in the rate of MACCEs between the treatment groups (7.8% vs. 8.4%; hazard ratio [HR] = 0.95, 95% confidence interval [CI] = 0.56–1.61, P = 0.855); however, a trend toward an increased bleeding rate was observed in the ticagrelor-based DAPT group (6.8% vs. 3.8%, HR = 1.84, 95% CI = 0.93–3.63, P = 0.079). Among patients with CKD stage III/IV but without ESRD (277 pairs), the ticagrelor-based DAPT group showed a reduced MACCE rate (3.6% vs. 8.7%, HR = 0.41, 95% CI = 0.19–0.86, P = 0.018) and a similar bleeding rate (5.1% vs. 3.2%, HR = 1.61, 95% CI = 0.70–3.71, P = 0.267), compared with those of the clopidogrel-based DAPT group.
Conclusion: The effects of ticagrelor-based DAPT on ischemic and bleeding outcomes of ACS patients with CKD varied according to CKD stage; in ACS patients with CKD without ESRD, ticagrelor-based DAPT reduced MACCE risk without increasing bleeding risks, relative to those observed with clopidogrel-based DAPT.

背景：以替格瑞洛为基础的双联抗血小板治疗（dual antiplatelet therapy，DAPT）对合并慢性肾脏病（chronic kidney disease，CKD）的急性冠状动脉综合征（acute coronary syndrome，ACS）患者的临床影响仍未明确。
方法：本研究从一项多中心注册研究中提取了1067例合并慢性肾脏病（含终末期肾病（end-stage renal disease，ESRD））且接受新一代药物洗脱支架植入术的急性冠状动脉综合征患者数据。本研究旨在比较接受替格瑞洛为基础的DAPT（n = 449）与氯吡格雷（clopidogrel）为基础的DAPT（n = 618）患者的临床结局。主要关注的结局为随访12个月时的主要不良心脑血管事件（major adverse cardiac and cerebrovascular events，MACCEs）以及出血学术研究联盟（Bleeding Academic Research Consortium，BARC）3级或5级出血事件。本研究开展了倾向得分匹配（propensity-score matching，PSM）分析，共匹配346对患者。
结果：终末期肾病患者的主要不良心脑血管事件及出血发生率最高（P < 0.001）。两组患者的主要不良心脑血管事件发生率无显著统计学差异（7.8% vs. 8.4%；风险比（hazard ratio，HR）= 0.95，95%置信区间（confidence interval，CI）= 0.56–1.61，P = 0.855）；但接受替格瑞洛为基础的DAPT组的出血发生率呈现升高趋势（6.8% vs. 3.8%，HR = 1.84，95%CI = 0.93–3.63，P = 0.079）。在未合并终末期肾病的Ⅲ/Ⅳ期慢性肾脏病患者中（共346对），与氯吡格雷为基础的DAPT组相比，替格瑞洛为基础的DAPT组主要不良心脑血管事件发生率更低（3.6% vs. 8.7%，HR = 0.41，95%CI = 0.19–0.86，P = 0.018），且两组出血发生率无显著差异（5.1% vs. 3.2%，HR = 1.61，95%CI = 0.70–3.71，P = 0.267）。
结论：以替格瑞洛为基础的双联抗血小板治疗对合并慢性肾脏病的急性冠状动脉综合征患者的缺血及出血结局的影响因慢性肾脏病分期而异；相较于氯吡格雷为基础的DAPT，在未合并终末期肾病的慢性肾脏病急性冠状动脉综合征患者中，替格瑞洛为基础的DAPT可降低主要不良心脑血管事件风险，且不增加出血风险。