title: Low responsiveness to clopidogrel increases risk among CKD patients undergoing coronary intervention.
abstract: Patients with CKD are at higher risk for major events after percutaneous coronary intervention (PCI) compared with subjects with normal renal function. The aims of this study were to evaluate responsiveness to clopidogrel in patients with CKD and to examine the effect of antiplatelet drug response on post-PCI outcome. We retrospectively evaluated a consecutive cohort of 1567 patients with symptomatic coronary artery disease undergoing PCI, 648 (41%) of whom had stage 3 to 5 CKD. We assessed responsiveness to clopidogrel by ADP-induced platelet aggregation after oral administration of a 600-mg clopidogrel loading dose and 100 mg of aspirin. In a multivariate survival analysis that included 1335 (85%) of the cohort, stage 3 to 5 CKD and low response to clopidogrel were independent predictors of the primary end point (composite of myocardial infarction, ischemic stroke, and death within 1 year). In summary, a low response to clopidogrel might be an additional risk factor for the poorer outcomes in patients with stage 3 to 5 CKD compared with patients with better renal function.
authors.affiliation: Medizinische Klinik III, Kardiologie und Kreislauferkrankungen, Universitätsklinikum der Eberhard-Karls-Universität Tübingen, Otfried-Müller-Strasse 10, 72076 Tübingen, Germany.
authors.forename: Patrik
authors.initials: P
authors.lastname: Htun
authors.forename: Suzanne
authors.initials: S
authors.lastname: Fateh-Moghadam
authors.forename: Christian
authors.initials: C
authors.lastname: Bischofs
authors.forename: Winston
authors.initials: W
authors.lastname: Banya
authors.forename: Karin
authors.initials: K
authors.lastname: Müller
authors.forename: Boris
authors.initials: B
authors.lastname: Bigalke
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stellos
authors.forename: Andreas E
authors.initials: AE
authors.lastname: May
authors.forename: Marcus
authors.initials: M
authors.lastname: Flather
authors.forename: Meinrad
authors.initials: M
authors.lastname: Gawaz
authors.forename: Tobias
authors.initials: T
authors.lastname: Geisler
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D001241:Aspirin / Q000009:adverse effects / Q000627:therapeutic use; D002908:Chronic Disease; D000077144:Clopidogrel; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000628:therapy*; D004305:Dose-Response Relationship, Drug; D004359:Drug Therapy, Combination; D005260:Female; D006470:Hemorrhage / Q000453:epidemiology; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D008297:Male; D008875:Middle Aged; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D012189:Retrospective Studies; D012307:Risk Factors; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine; D001241:Aspirin