Open AccessBenefit of Clopidogrel Therapy in Patients With Myocardial Infarction and Chronic Kidney Disease—A Danish Nation‐Wide Cohort Study
Author(s) -
Blicher Thalia Marie,
Hommel Kristine,
Kristensen Søren Lund,
TorpPedersen Christian,
Madsen Mette,
Kamper AnneLise,
Olesen Jonas Bjerring
Publication year - 2014
Publication title -
journal of the american heart association
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.494
H-Index - 85
ISSN - 2047-9980
DOI - 10.1161/jaha.114.001116
Subject(s) - medicine , clopidogrel , percutaneous coronary intervention , conventional pci , hazard ratio , myocardial infarction , kidney disease , proportional hazards model , clinical endpoint , cohort , cardiology , confidence interval , randomized controlled trial
Background The aim of the present study was to evaluate clopidogrel treatment after incident myocardial infarction ( MI ) in patients with and without chronic kidney disease ( CKD ). Methods and Results By linking nation‐wide registries, information about patients admitted with incident MI was found. Primary endpoints were all‐cause and cardiovascular ( CV ) mortality, a composite of all‐cause mortality and recurrent MI , and a composite of fatal and nonfatal bleedings. Effect of clopidogrel use versus clopidogrel nonuse was estimated using an adjusted Cox's regression model stratified according to percutaneous coronary intervention ( PCI ) treatment. A total of 69 082 incident MI patients in the period 2002–2011 were included. Clopidogrel treatment was associated with hazard ratios ( HR s) for the combined endpoint of all‐cause mortality and recurrent MI in PCI ‐treated patients of 0.90 (95% confidence interval [ CI ], 0.47 to 1.72) in renal replacement therapy ( RRT ) patients, 0.59 (95% CI : 0.40 to 0.88) in non‐end‐stage CKD patients and 0.69 (95% CI , 0.61 to 0.77) in patients without kidney disease ( P for interaction=0.60). In patients not treated with PCI , HR s were 0.90 (95% CI , 0.68 to 1.21) in RRT patients, 0.86 (95% CI , 0.75 to 0.99) in non‐end‐stage CKD patients, and 0.91 (95% CI , 0.87 to 0.95) in patients without kidney disease ( P for interaction=0.74). An increase in bleeding events (not significant) was noted for clopidogrel‐treated patients not undergoing PCI and for non‐end‐stage CKD patients undergoing PCI , whereas clopidogrel was associated with less bleedings in PCI ‐treated RRT patients and patients without kidney disease. Conclusions During a 1‐year follow‐up, after MI , clopidogrel was associated with improved outcomes in patients with non‐end‐stage CKD . Even though no effect difference, compared to patients without CKD , was observed, the benefit associated with the use of clopidogrel after MI in patients requiring RRT is less clear.