Prasugrel-Based De-Escalation in Patients With Acute Coronary Syndrome According to Renal Functionopen access
- Authors
- Yun, J.P.; Kang, J.; Park, K.W.; Park, K.; Hwang, D.; Han, J.-K.; Yang, H.-M.; Kang, H.-J.; Koo, B.-K.; Chae, I.-H.; Moon, K.-W.; Park, H.W.; Won, K.-B.; Jeon, D.W.; Han, K.-R.; Choi, S.W.; Ryu, J.K.; Jeong, M.H.; Kim, H.-S.
- Issue Date
- Feb-2023
- Publisher
- Elsevier Inc.
- Keywords
- acute coronary syndrome; chronic kidney disease; prasugrel
- Citation
- JACC: Asia, v.3, no.1, pp 51 - 61
- Pages
- 11
- Journal Title
- JACC: Asia
- Volume
- 3
- Number
- 1
- Start Page
- 51
- End Page
- 61
- URI
- https://scholarworks.bwise.kr/cau/handle/2019.sw.cau/75114
- DOI
- 10.1016/j.jacasi.2022.09.013
- ISSN
- 2772-3747
- Abstract
- Background: Patients with coronary artery disease and impaired renal function are at higher risk for both bleeding and ischemic adverse events after percutaneous coronary intervention (PCI). Objectives: This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function. Methods: We conducted a post hoc analysis of the HOST-REDUCE-POLYTECH-ACS study. Patients with available estimated glomerular filtration rate (eGFR) (n = 2,311) were categorized into 3 groups. (high eGFR: >90 mL/min; intermediate eGFR: 60 to 90 mL/min; and low eGFR: <60 mL/min). The end points were bleeding outcomes (Bleeding Academic Research Consortium type 2 or higher), ischemic outcomes (cardiovascular death, myocardial infarction, stent thrombosis, repeated revascularization, and ischemic stroke), and net adverse clinical event (including any clinical event) at 1-year follow-up. Results: Prasugrel de-escalation was beneficial regardless of baseline renal function (P for interaction = 0.508). The relative reduction in bleeding risk from prasugrel de-escalation was higher in the low eGFR group than in both the intermediate and high eGFR groups (relative reductions, respectively: 64% (HR: 0.36; 95% CI: 0.15-0.83) vs 50% (HR: 0.50; 95% CI: 0.28-0.90) and 52% (HR: 0.48; 95% CI: 0.21-1.13) (P for interaction = 0.646). Ischemic risk from prasgurel de-escalation was not significant in all eGFR groups (HR: 1.18 [95% CI: 0.47-2.98], HR: 0.95 [95% CI: 0.53-1.69], and HR: 0.61 [95% CI: 0.26-1.39]) (P for interaction = 0.119). Conclusions: In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function. © 2023 The Authors
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