Abstract 20071: Clinical Benefits of New P2y12 Inhibitors According to Renal Function in Patients With Acute Myocardial Infarction: The Results of Korean Myocardial Infarction-Nih Registry
Background: Clinical benefits of new P2Y12 inhibitors according to renal function have been rarely clarified in real clinical world.
Methods: Patients were derived from 11,608 consecutive patients with acute myocardial infarction (AMI) undergoing percutaneous coronary intervention (PCI) between 2014 and 2015. Chronic kidney disease (CKD) was defined as glomerular filtration rate <60ml/min/1.73m2 by CKD-EPI equation. The primary efficacy endpoint was the composite of all-cause death, recurrent MI, or ischemic stroke. The primary safety endpoint was the rate of TIMI major bleeding. Net clinical outcome was the composite of the primary efficacy and safety endpoints. Because new P2Y12 inhibitors were given to lower risk patients compared to clopidogrel, we adjusted the differences of baseline characteristics with propensity score matching.
Results: In patients without CKD (n=3,232), the primary efficacy outcome was significantly reduced by new P2Y12 inhibitors (2.6% vs. 1.1%; Hazard ration [HR]=0.402; 95% confidence interval [CI]=0.230-0.702; P=0.001), which was mainly derived from the reduction of in-hospital death (2.0% vs. 0.6%; HR=0,308; 95% CI=0.153-0.621; P=0.001). Conversely, in patients without CKD (n=1057), new P2Y12 inhibitors did not show the reduction of neither the primary efficacy endpoint (11.0% vs. 9.8%; HR=0.880; 95% CI=0.590-1.313; P=0.545) nor of in-hospital death (9.7% vs. 8.5%; HR=0,868; 95% CI=0.567-0.765; P=1.329). The primary safety endpoint was similar between New P2Y12 inhibitors and clopidogrel in both non-CKD and CKD patients (2.0% vs. 2.4%; HR=1.227; 95% CI=0.759-1.985; P=0.469 in non-CKD patients vs. 3.5% vs. 4.1%; HR=1.191; 95% CI=0.633-2.243; P=0.627 in CKD patients). Net clinical outcome with new P2Y12 inhibitors were also neutral in both non-CKD and CKD patients (4.0% vs. 3.3%; HR=0,832; 95% CI=0.575-1.203; P=0.344 in non-CKD patients vs. 13.0% vs. 12.9%; HR=0.988; 95% CI=0.687-1.419; P=1.000 in CDK patients).
Conclusions: In real clinical world, clinical benefits of new P2Y12 inhibitors in AMI patients undergoing PCI were more prominent in non-CKD patients than CKD patients. Importantly, compared to clopidogrel, new P2Y12 inhibitors reduced in-hospital death in non-CKD patients.
Author Disclosures: Y. Park: Other; Significant; This research was supported by a fund(2013-E63005-02) by Research of Korea Centers for Disease Control and Prevention.. C. Kwak: None. J. Hwang: None. M. Jeong: None. K. Park: None. R. Kim: None.
- © 2016 by American Heart Association, Inc.