Abstract 14435: Effects of Clopidogrel on Mortality, Cardiovascular and Bleeding Outcomes in Patients with Chronic Kidney Disease - Data from Taiwan Acute Coronary Syndrome Full Spectrum Registry

Abstract

Background Although clopidogrel decreases cardiovascular events in patients suffering from acute coronary syndrome (ACS), its effect is inconclusive in the chronic kidney disease (CKD) population. Furthermore, patients with renal dysfunction are more prone to bleeding when receiving antiplatelet therapy. Therefore, we sought to determine the efficacy and safety of in-hospital and long-term clopidogrel therapy in patients with ACS and CKD.

Methods In a Taiwan national-wide registry, 2819 ACS patients were enrolled. CKD is defined as an estimated glomerular filtration rate of less than 60 ml/min per 1.73 m2 using the Modification of Diet in Renal Disease Study equation. The primary endpoints are the combined outcomes of death, non-fatal myocardial infarction and stroke at discharge and 12 months.

Results Overall 949 (33.7%) patients had CKD and 2660 (94.36%) received clopidogrel treatment. CKD is associated with increased risk of the primary endpoint at discharge and 12 months (adjusted OR 3.06, 95% CI: 1.75-5.34 and adjusted HR 2.39, 95% CI: 1.82 to 3.15, both p < 0.01 respectively). Use of clopidogrel is associated with reduced risk of the primary endpoint at 12 months (adjusted HR 0.39, 95% CI: 0.27-0.56, p < 0.01). The Kaplan-Meier curves show clopidogrel significantly lowers primary endpoint both in the CKD and non-CKD population during 12 months follow-up (both p < 0.01). Cox regression analysis showed that clopidogrel reduced death and primary endpoints both for CKD (HR 0.34, 95% CI: 0.20-0.58 and HR 0.45, 95% CI: 0.28-0.71, both p < 0.01, respectively) and non-CKD (HR 0.20, 95% CI: 0.09-0.46; HR 0.38, 95% CI: 0.21-0.68, both p < 0.01, respectively) population after adjusting for age, gender, Killip class, hypertension, diabetes mellitus and smoking. Clopidogrel treatment was not associated with increased in-hospital TIMI bleeding in all, non-CKD and CKD population.

Conclusion The beneficial effect of clopidogrel on mortality and cardiovascular outcomes without increasing bleeding hazard is found not only in the non-CKD population but also in the CKD patients.