Antiplatelet Therapy in Acute Coronary Syndrome Patients With Impaired Renal Function

Objective: To determine the prevalence of first diagnosed atrial fibrillation in patients admitted with acute coronary syndrome and with impaired renal function with and without diabetes mellitus. Methodology: A total of 434 patients were selected from two different hospitals, 361 from NICVD, Tando Muhammad Khan and 73 from Isra University Hospital, Hyderabad. Both males and females, aged between 18 years to 70 years, first ever presented & admitted with acute coronary syndrome (ACS) and renal impairment were included and whereas, patients with atrial fibrillation (AF) other than first diagnosed, previous history of myocardial infarction/coronary artery bypass grafting (CABG), known case of chronic kidney disease/on dialysis, history of cerebrovascular accident (CVA), patient with valvular heart disease, and pregnant women were excluded from this study. Baseline and clinical data was collected to determine the association with the prevalence of first diagnosed AF through chi-square test and a p value of <0.05 was considered as statistically significant. Results: The mean age ± SD was 49.32±12.47 years. Among them majority were males 66.35% and rural residents 51.15% respectively. The most common risk factor observed in our study was presence of hypertension (N = 231, 53.22%) and among all ACS patients, most common type of ACS was unstable angina (N = 195, 44.93%). The overall prevalence of first diagnosed atrial fibrillation was 12.44% (N = 54) and the overall prevalence of diabetes mellitus was 39.63% (N = 172). Mean random blood sugar levels in diabetic patients was 203.32±105.60 mg/dL, hypertensive patients with DM (48.14%), and patients with STEMI with DM (12.96%) were significantly associated with increased prevalence of first diagnosed atrial fibrillation, p value <0.05. Conclusion: Prevalence of first diagnosed AF is comparatively higher in our study because of the underlying renal impairment. Modifiable risk factor like uncontrolled blood sugar levels has significance association with first diagnosed AF.

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Contemporary Antiplatelet Treatment in Acute Coronary Syndrome Patients with Impaired Renal Function Undergoing Percutaneous Coronary Intervention

Cardiology ◽

10.1159/000477798 ◽

2017 ◽

Vol 138 (3) ◽

pp. 186-194 ◽

Cited By ~ 2

Author(s):

Periklis Davlouros ◽

Ioanna Xanthopoulou ◽

John Goudevenos ◽

Michalis Hamilos ◽

Emmanouil Vavuranakis ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Renal Function ◽

Real World ◽

Impaired Renal Function ◽

Major Adverse Cardiovascular Events ◽

Multicenter Cohort Study ◽

Risk Of Death ◽

Coronary Syndrome ◽

Percutaneous Coronary

Objectives: To assess the clinical impact of impaired renal function (IRF), in “real-world” acute coronary syndrome (ACS) patients, receiving clopidogrel, prasugrel, or ticagrelor. Methods: This was a prospective, observational, multicenter, cohort study of ACS patients undergoing percutaneous coronary interventions (PCI) with IRF (creatinine clearance <60 mL/min by Cockroft-Gault equation), who were recruited into the Greek Antiplatelet Registry (GRAPE). Patients were followed-up until 1 year for major adverse cardiovascular events (MACE; a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and BARC (Bleeding Academic Research Consortium) bleeding. Results: Out of 2,047 registered patients, there were 344 (16.8%) with IRF. At the 1-year follow-up, MACE occurred in 18.6 and 6.2% of those patients with and without IRF, respectively: adjusted hazard ratio (HR) = 2.13 (95% confidence interval, CI 1.16-3.91), p = 0.02. IRF patients were also at higher risk of death and BARC type ≥2 and ≥3 bleeding: adjusted HR = 3.55 (95% CI 1.73-7.27), p = 0.001; HR = 2.75 (95% CI 1.13-6.68), p = 0.03; and HR = 6.02 (95% CI 2.30-15.77), p < 0.001, respectively. Combined MACE and BARC type ≥2 bleeding occurred in 34.0 and 14.0% of those with and without IRF, respectively: adjusted HR = 2.65 (95% CI 1.36-5.16), p = 0.004. At discharge, clopidogrel was more frequently prescribed in IRF patients (61.0 vs. 33.1%, p < 0.001). Conclusions: Real-world ACS patients with IRF subjected to PCI demonstrate higher thrombotic and bleeding risks than patients with normal renal function.

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Impact of Impaired Renal Function and Diabetes on Long-Term Prognosis in Patients Undergoing Primary Angioplasty for Acute Coronary Syndrome

Internal Medicine ◽

10.2169/internalmedicine.47.0932 ◽

2008 ◽

Vol 47 (10) ◽

pp. 907-913 ◽

Cited By ~ 8

Author(s):

Kenji Goto ◽

Nobuo Shiode ◽

Kinya Shirota ◽

Yukihiro Fukuda ◽

Fumiyo Kitamura ◽

...

Keyword(s):

Acute Coronary Syndrome ◽

Renal Function ◽

Impaired Renal Function ◽

Primary Angioplasty ◽

Coronary Syndrome ◽

Long Term Prognosis

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LONG-TERM ISCHEMIC AND BLEEDING RISK WITH EXTENDED DUAL ANTIPLATELET THERAPY AFTER PCI IN HIGH-RISK “TWILIGHT-LIKE” PATIENTS WITH ACUTE CORONARY SYNDROME

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02590-0 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1231

Author(s):

Haoyu Wang ◽

Dong Yin ◽

Bo Xu ◽

Kefei Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Dual Antiplatelet Therapy ◽

Bleeding Risk ◽

Coronary Syndrome

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Benefit and Harm of Extended Dual Antiplatelet Therapy After PCI in high-risk TWILIGHT-like patients with acute coronary syndrome

European Heart Journal Acute Cardiovascular Care ◽

10.1093/ehjacc/zuab020.101 ◽

2021 ◽

Vol 10 (Supplement_1) ◽

Author(s):

HY Wang ◽

R Zhang ◽

ZX Cai ◽

KF Dou

Keyword(s):

Acute Coronary Syndrome ◽

High Risk ◽

Antiplatelet Therapy ◽

Cardiovascular Death ◽

Secondary Outcome ◽

Short Term ◽

Bleeding Events ◽

Coronary Syndrome

Abstract Funding Acknowledgements Type of funding sources: None. Background Recent emphasis on reduced duration and/or intensity of antiplatelet therapy following PCI irrespective of indication for PCI may fail to account for the substantial risk of subsequent nontarget lesion events in acute coronary syndrome (ACS) patients. This study sought to investigate the beneﬁts and risks of extended-term (>12-month) DAPT as compared with short-term DAPT in high-risk "TWILIGHT-like" ACS patients undergoing PCI. Methods All consecutive patients fulﬁlling the "TWILIGHT-like" criteria undergoing PCI from January 2013 to December 2013 were identiﬁed from the prospective Fuwai PCI Registry. High-risk "TWILIGHT-like" patients were deﬁned by at least 1 clinical and 1 angiographic feature based on TWILIGHT trial selection criteria. The present analysis evaluated 4,875 high-risk "TWILIGHT-like" patients with ACS who were event-free at 12 months after PCI. The primary outcome was the composite of all-cause death, myocardial infarction (MI), or stroke at 30 months while BARC type 2, 3, or 5 bleeding was key secondary outcome. Results Extended DAPT compared with shorter DAPT reduced the composite outcome of all-cause death, MI, or stroke by 63% (1.5% vs. 3.8%; HRadj: 0.374, 95% CI: 0.256 to 0.548; HRmatched: 0.361, 95% CI: 0.221-0.590). The HR for cardiovascular death was 0.049 (0.007 to 0.362) and that for MI 0.45 (0.153 to 1.320) and definite/probable stent thrombosis 0.296 (0.080-1.095) in propensity-matched analyses. Rates of BARC type 2, 3, or 5 bleeding (0.9% vs. 1.3%; HRadj: 0.668 [0.379 to 1.178]; HRmatched: 0.721 [0.369-1.410]) did not differ significantly in patients treated with DAPT > 12-month or DAPT ≤ 12-month. The effect of long-term DAPT on primary and key secondary outcome across the proportion of ACS patients with 1-3, 4-5, or 6-9 risk factors showed a consistent manner (Pinteraction > 0.05). Conclusion Among high-risk "TWILIGHT-like" patients with ACS after PCI, long-term DAPT reduced ischemic events without increasing clinically meaningful bleeding events as compared with short-term DAPT, suggesting that extended DAPT might be considered in the treatment of ACS patients who present with a particularly higher risk for thrombotic complications. Abstract Figure.

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