Author + information
- Jennifer Rymera,b,
- Lisa Kaltenbacha,b,
- Jacob Dolla,b,
- John Messengera,b,
- Eric Petersona,b and
- Tracy Wanga,b
Background: Myocardial infarction (MI) is common among patients with chronic kidney disease (CKD). Little is known about the incidence of post-MI bleeding and premature P2Y12 inhibitor therapy discontinuation among CKD patients.
Methods: We examined MI patients treated with percutaneous coronary intervention (PCI) and discharged alive on a P2Y12 inhibitor at 233 US hospitals in the TRANSLATE-ACS study. Rates of GUSTO severe/moderate bleeding and P2Y12 inhibitor discontinuation before 1 year post-MI were compared among patients with creatinine clearance (CrCl) <30/dialysis, 30-59, 60-89, and ≥90 mL/min.
Results: Among 11,108 PCI-treated MI patients, 4% had a CrCl<30, 27% a CrCl of 30-59, and 42% a CrCl of 60-89. Drug eluting stents were used in 72% of patients regardless of CKD severity. Higher potency P2Y12 inhibitors were less likely to be prescribed to patients with lower CrCl, but used in 21% of patients with CrCl <60. Within 1 year of discharge, patients with lower CrCl had greater unadjusted and adjusted risk of GUSTO severe/moderate bleeding (Table). Patients with CrCl<30 trended towards higher rates of premature P2Y12 inhibitor cessation and shorter time to P2Y12 inhibitor discontinuation. Interruptions in P2Y12 inhibitor therapy due to bleeding were more frequent in patients with lower CrCl regardless of P2Y12 inhibitor type.
Conclusions: CKD is common among PCI-treated MI patients and associated with higher risk of bleeding and premature cessation of P2Y12 inhibitor treatment post-discharge.
Poster Hall, Hall C
Sunday, March 19, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Antiplatelet and Antithrombotic Agents in Ischemic Heart Disease
Abstract Category: 3. Acute and Stable Ischemic Heart Disease: Therapy
Presentation Number: 1296-308
- 2017 American College of Cardiology Foundation