Associations between Chronic Kidney Disease (CKD) and Outcomes with Use of Prasugrel/ Ticagrelor Versus Clopidogrel in Patients with ACS Undergoing PCI: A Single Center Analysis - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

abed el rahim samara Cardiology, Rabin Medical Center, Israel Hana Vaknin Cardiology, Rabin Medical Center, Israel Tamir Bental Cardiology, Rabin Medical Center, Israel Ran Kornowski Cardiology, Rabin Medical Center, Israel Gabriel Greenberg Cardiology, Rabin Medical Center, Israel Leor Perl Cardiology, Rabin Medical Center, Israel Alon Eisen Cardiology, Rabin Medical Center, Israel Pablo Codner Cardiology, Rabin Medical Center, Israel Katia Orvin Cardiology, Rabin Medical Center, Israel Abid Assali Cardiology, Rabin Medical Center, Israel

Background:

Patients with chronic kidney disease (CKD) represent an increasing proportion of the population undergoing percutaneous coronary intervention (PCI). These patients are at high risk for cardiovascular events and generally have a worse adverse out-comes after PCI. The data whether newer anti-platelet drugs offer a superior outcome compared to Clopidogrel in these patients are limited.

Objectives:

The study aimed to compare the anti-platelet efficacy of Clopidogrel to Ticagrelor or Prasugrel in acute coronary syndrome (STEMI/NSTEMI) patients with significant CKD.

Methods:

We evaluated the composite primary outcome of death, MI, TVR and CABG in 1944 patients from our registry in Rabin Medical Center in Israel, who were admitted with ACS and significant CKD (defined as GFR below 60ml/min/1.73m² by MDRD equation) between 2004 and 2017.

Results:

The mean age was 73.4±10.6 and 34.9% were females. The mean GFR was 42.7±14.8 ml/min/1.73m². There was 264 STEMI Patients (13.6%) and all patients underwent PCI. All patients were treated with Aspirin combined with P2Y12 inhibitor: 1624 patients (83.5%) on Clopidogrel, 239 (12.3%) on Ticagrelor and 81 patients (4.2%) on Prasugrel. The year of index event, age, stroke and the need for anti-coagulation were the main variables to influence the decision on the DAPT type.

The composite primary outcome at one year was 26.1%, 17.8% and 10.3% in the Clopidogerl, Ticagrelor and prasugrel group respectively. At mid-term of 3 years follow up, the primary outcome was 43.2%, 29.1% and 20.4% respectively. No statistical significance was seen between Prasugrel and Ticagrelor [P=0.128] while Clopidogrel was inferior for both [P<0.001] in the short and mid-term follow up.

Conclusion:

The present study demonstrates that Ticagrelor and Prasugrel are superior to Clopidogrel in ACS with CKD. Further studies are needed to confirm our finding.