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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.

Benefit of Clopidogrel Therapy in Patients With Myocardial Infarction and Chronic Kidney Disease—A Danish Nation‐Wide Cohort Study