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논문분류	춘계학술대회 초록집
제목	Clinical Outcomes of Prolonged Dual Antiplatelet Therapy after Coronary Drug-Eluting Stent Implantation in Dialysis Patients: a population-based study
저자	Seokwoo Park, Yaerim Kim, Hyung Ah Jo, Soojin Lee, Bo Ram Yang, Joongyub Lee, Chun Soo Lim, Yon Su Kim, Dong Ki Kim
출판정보	2019; 2019(1):
키워드	Coronary artery disease \| Drug-eluting stents \| End-stage renal disease \| Percutaneous coronary intervent \| Renal dialysis
초록	End-stage renal disease (ESRD) is susceptible to both ischemic and bleeding events. Optimal duration of dual antiplatelet therapy (DAPT) after drug-eluting stent (DES) implantation is not established in dialysis patients who are usually excluded from randomized studies. Since recent studies reported benefits of prolonged DAPT over 12 months in chronic kidney disease, we investigated the effectiveness and safety of prolonged DAPT specifically in ESRD with higher cardiovascular risks. In this population-based retrospective study using healthcare claims data, dialysis patients who underwent DES implantation from 2008 to 2015 were initially enrolled. Landmark analyses including free-of-event participants at 12 (n=2,246), 15 (n=1,925), and 18 (n=1,692) months after DES implantation were performed to comapre the effects of continued versus discontinued DAPT on clinical outcomes. The primary outcome was major adverse cardiovascular events (MACE), a composite of mortality, non-fatal myocardial infarction, coronary revascularization, and stroke. Major bleeding was analyzed as a safety outcome. Inverse probability weighted (IPTW) Cox regressions were performed to address selection biases. Mean follow-up periods were 278.3 to 292.4 days depending on landmarks. Incidences were lower for MACE and higher for major bleeding in continued DAPT groups. Incidences of major bleeding were far lower than those of MACE. In IPTW Cox analyses, continued DAPT reduced the hazards of MACE at 12- (HR, 0.74; 95% CI, 0.61-0.90; P=0.003), 15- (HR, 0.78; 95% CI, 0.64-0.96; P=0.02), and 18-month (HR, 0.79; 95% CI, 0.63-0.99; P=0.04) landmarks, but without significant increase in major bleeding at 12- (HR, 1.39; 95% CI, 0.90-2.16; P=0.1), 15- (HR, 1.13; 95% CI, 0.75-1.70; P=0.6), and 18-month (HR, 1.27; 95% CI, 0.83-1.95; P=0.3) landmarks. Prolonged DAPT over 12 months after DES implantation can reduce MACE without significant increase in major bleeding in dialysis patients. Dialysis might be a risk factor for ischemic complications rather than bleeding in deciding on DAPT duration.
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