Renal Function-Stratified Comparison of Short- and Long-Term Dual Antiplatelet Therapy in Patients Undergoing...

Area of Science:

• Cardiology
• Nephrology
• Interventional Cardiology

Background:

• Optimal duration of dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) with third-generation drug-eluting stents (DES) is uncertain in patients with chronic kidney disease (CKD).
• CKD is associated with increased risks of both thrombotic and bleeding events.

Purpose of the Study:

• To evaluate the efficacy and safety of 3- to 6-month DAPT versus 12-month DAPT in patients with varying degrees of renal function undergoing PCI with third-generation DES.
• To determine if renal function influences the optimal DAPT duration.

Main Methods:

• A prespecified post hoc analysis of the HOST-IDEA trial involving 1,997 patients undergoing PCI with third-generation DES.
• Patients were randomized to 3- to 6-month or 12-month DAPT and grouped by estimated glomerular filtration rate (eGFR): high (>90), intermediate (60-90), and low (<60 mL/min/1.73 m²).
• Primary outcome was net adverse clinical events (NACE) at 12 months; secondary outcomes included target lesion failure (TLF) and major bleeding.

Main Results:

• The low eGFR group exhibited higher rates of NACE, TLF, and major bleeding compared to intermediate and high eGFR groups.
• Rates of NACE were similar between 3- to 6-month and 12-month DAPT across all eGFR categories (high, intermediate, and low).
• No significant interaction was observed between DAPT duration and eGFR for NACE, indicating consistent outcomes regardless of renal function.

Conclusions:

• Three to six months of DAPT is clinically comparable to 12 months of DAPT in patients undergoing PCI with third-generation DES.
• This finding applies irrespective of the patient's renal function status.
• Shorter DAPT duration can be considered for patients with CKD undergoing PCI with modern DES.