Renal function and outcomes in acute coronary syndrome: Impact of clopidogrel

M. Keltai, Marcello Tonelli, Johannes F E Mann, Eva Sitkei, Basil S. Lewis, Steven Hawken, Shamir R. Mehta, Salim Yusuf

Research output: Contribution to journalArticle

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Abstract

INTRODUCTION: Patients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes. METHODS AND RESULTS: Patients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12 253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel to standard treatment in non-ST elevation acute coronary syndrome was observed in all three tertiles of renal function {(lower third relative risk (RR)=0.89 [95% confidence interval (CI) 0.76-1.05]; medium third RR=0.68 (95% CI 0.56-0.84); upper third RR=0.74 (95% CI 0.60-0.93) (P for heterogeneity=0.11)}. Clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function. The risk of major or life-threatening bleeding increased moderately with the addition of clopidogrel to standard treatment [lower third RR=1.12 (95% CI 0.83-1.51); medium third RR=1.4 (95% CI 0.97-2.02); upper third RR=1.83 (95% CI 1.23-2.73)], but this did not appear to be greatest in those with the lowest renal function. CONCLUSIONS: Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes. Clopidogrel was beneficial and safe in patients with and without chronic kidney disease.

Original languageEnglish
Pages (from-to)312-318
Number of pages7
JournalEuropean Journal of Cardiovascular Prevention and Rehabilitation
Volume14
Issue number2
DOIs
Publication statusPublished - Apr 2007

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clopidogrel
Acute Coronary Syndrome
Kidney
Confidence Intervals
Glomerular Filtration Rate
Chronic Renal Insufficiency
Hemorrhage
Unstable Angina

Keywords

  • Kidney
  • Myocardial infarction
  • Platelet aggregation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Rehabilitation
  • Public Health, Environmental and Occupational Health

Cite this

Renal function and outcomes in acute coronary syndrome : Impact of clopidogrel. / Keltai, M.; Tonelli, Marcello; Mann, Johannes F E; Sitkei, Eva; Lewis, Basil S.; Hawken, Steven; Mehta, Shamir R.; Yusuf, Salim.

In: European Journal of Cardiovascular Prevention and Rehabilitation, Vol. 14, No. 2, 04.2007, p. 312-318.

Research output: Contribution to journalArticle

Keltai, M. ; Tonelli, Marcello ; Mann, Johannes F E ; Sitkei, Eva ; Lewis, Basil S. ; Hawken, Steven ; Mehta, Shamir R. ; Yusuf, Salim. / Renal function and outcomes in acute coronary syndrome : Impact of clopidogrel. In: European Journal of Cardiovascular Prevention and Rehabilitation. 2007 ; Vol. 14, No. 2. pp. 312-318.
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AU - Keltai, M.

AU - Tonelli, Marcello

AU - Mann, Johannes F E

AU - Sitkei, Eva

AU - Lewis, Basil S.

AU - Hawken, Steven

AU - Mehta, Shamir R.

AU - Yusuf, Salim

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N2 - INTRODUCTION: Patients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes. METHODS AND RESULTS: Patients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12 253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel to standard treatment in non-ST elevation acute coronary syndrome was observed in all three tertiles of renal function {(lower third relative risk (RR)=0.89 [95% confidence interval (CI) 0.76-1.05]; medium third RR=0.68 (95% CI 0.56-0.84); upper third RR=0.74 (95% CI 0.60-0.93) (P for heterogeneity=0.11)}. Clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function. The risk of major or life-threatening bleeding increased moderately with the addition of clopidogrel to standard treatment [lower third RR=1.12 (95% CI 0.83-1.51); medium third RR=1.4 (95% CI 0.97-2.02); upper third RR=1.83 (95% CI 1.23-2.73)], but this did not appear to be greatest in those with the lowest renal function. CONCLUSIONS: Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes. Clopidogrel was beneficial and safe in patients with and without chronic kidney disease.

AB - INTRODUCTION: Patients with renal dysfunction are more prone to bleeding when receiving antithrombotic drugs. The aim of the study was to assess the impact of clopidogrel on safety and efficacy in patients with renal dysfunction in non-ST elevation acute coronary syndromes. METHODS AND RESULTS: Patients in the Clopidogrel in Unstable Angina to Prevent Recurrent Events (CURE) trial were analysed to assess the relationship of chronic kidney disease to cardiovascular outcomes. Renal function was estimated by the glomerular filtration rate computed from the baseline serum creatinine measurements in 12 253 (97.5%) patients enrolled in the trial. Patients were grouped into tertiles of glomerular filtration rate. The primary outcome (cardiovascular death, myocardial infarction, stroke combined) occurred more frequently in the lowest glomerular filtration rate tertile. The bleeding risk was also significantly increased in patients in this tertile, compared with the other two. The beneficial effect of adding clopidogrel to standard treatment in non-ST elevation acute coronary syndrome was observed in all three tertiles of renal function {(lower third relative risk (RR)=0.89 [95% confidence interval (CI) 0.76-1.05]; medium third RR=0.68 (95% CI 0.56-0.84); upper third RR=0.74 (95% CI 0.60-0.93) (P for heterogeneity=0.11)}. Clopidogrel treatment significantly increased the risk of minor bleeding in all tertiles of renal function. The risk of major or life-threatening bleeding increased moderately with the addition of clopidogrel to standard treatment [lower third RR=1.12 (95% CI 0.83-1.51); medium third RR=1.4 (95% CI 0.97-2.02); upper third RR=1.83 (95% CI 1.23-2.73)], but this did not appear to be greatest in those with the lowest renal function. CONCLUSIONS: Even mild chronic kidney disease worsens the prognosis in patients with non-ST elevation acute coronary syndromes. Clopidogrel was beneficial and safe in patients with and without chronic kidney disease.

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