title: Impact of Clopidogrel loading dose in patients with chronic kidney disease undergoing primary percutaneous coronary intervention for ST-segment elevation myocardial infarction.
abstract: The optimal loading dose of clopidogrel in patients with chronic kidney disease who undergo primary percutaneous coronary intervention for ST-segment elevation myocardial infarction has not been investigated. The aim of this study was to assess the impact of clopidogrel loading dose on clinical outcomes in this setting. A total of 1,457 patients with CKD (estimated glomerular filtration rate <60 ml/min/1.73 m(2)) were evaluated according to clopidogrel loading dose: 600 mg (n = 861) versus 300 mg (n = 596). In-hospital complications, including major bleeding and clinical outcomes at 1 and 12 months, were compared between the 2 groups. The in-hospital major bleeding rate was similar (0.8% vs 0.2%, p = 0.09). Also, there were no differences in major adverse cardiac event rates, including death, recurrent myocardial infarction, target lesion revascularization, and stent thrombosis, at 1 month (15.6% vs 16.4%, p = 0.70) and 12 months (19.0% vs 21.3%, p = 0.32). On multivariate analysis, a 600-mg loading dose of clopidogrel was not an independent predictor of 1-month (odds ratio 1.13, 95% confidence interval 0.49 to 2.57, p = 0.78) and 12-month (odds ratio 0.89, 95% confidence interval 0.52 to 1.51, p = 0.66) major adverse cardiac events. After propensity score-matched analysis, these results were unchanged. In conclusion, a 600-mg loading dose of clopidogrel was not effective in reducing 1- and 12-month major adverse cardiac events in patients with chronic kidney disease who underwent primary percutaneous coronary intervention for ST-segment elevation myocardial infarction, but this dose did not increase the in-hospital major bleeding rate.
authors.affiliation: Hanyeo Expo Hospital, Yeosu, Korea.
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Kim
authors.forename: Myung Ho
authors.initials: MH
authors.lastname: Jeong
authors.forename: Jae Hyun
authors.initials: JH
authors.lastname: Moon
authors.forename: Yong Keun
authors.initials: YK
authors.lastname: Ahn
authors.forename: Shung Chull
authors.initials: SC
authors.lastname: Chae
authors.forename: Seung Ho
authors.initials: SH
authors.lastname: Hur
authors.forename: Taek Jong
authors.initials: TJ
authors.lastname: Hong
authors.forename: Young Jo
authors.initials: YJ
authors.lastname: Kim
authors.forename: In Whan
authors.initials: IW
authors.lastname: Seong
authors.forename: In Ho
authors.initials: IH
authors.lastname: Chae
authors.forename: Myeong Chan
authors.initials: MC
authors.lastname: Cho
authors.forename: Yang Soo
authors.initials: YS
authors.lastname: Jang
authors.forename: Jung Han
authors.initials: JH
authors.lastname: Yoon
authors.forename: Ki Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung Jung
authors.initials: SJ
authors.lastname: Park
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D000077144:Clopidogrel; D004305:Dose-Response Relationship, Drug; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000503:physiopathology / Q000628:therapy*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D051436:Renal Insufficiency, Chronic / Q000150:complications* / Q000401:mortality; D056910:Republic of Korea / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives*
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine