PDF(Pubmed)
Abstract：
UNASSIGNED: 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).
UNASSIGNED: This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.
UNASSIGNED: This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function.
UNASSIGNED: 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.
UNASSIGNED: 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).
UNASSIGNED: In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.
摘要：
未经证实：患有冠状动脉疾病和肾功能受损的患者在经皮冠状动脉介入治疗（PCI）后发生出血和缺血性不良事件的风险更高。
UNASSIGNED：本研究评估了基于普拉格雷的降阶梯策略在肾功能受损患者中的疗效和安全性。
未经评估：我们对HOST-REDUCE-POLYTECH-ACS研究进行了事后分析。将具有估计肾小球滤过率（eGFR）的患者（n=2,311）分为3组。(高eGFR:>90mL/min;中等eGFR:60至90mL/min;和低eGFR:<60mL/min)。终点是出血结果（出血学术研究联盟2型或更高），缺血性结局(心血管死亡，心肌梗塞,支架内血栓形成,反复血运重建,和缺血性中风)，和1年随访时的净不良临床事件（包括任何临床事件）。
未经评估：无论基线肾功能如何，普拉格雷降阶梯都是有益的（相互作用的P=0.508）。低eGFR组的普拉格雷降低出血风险的相对降低高于中eGFR组和高eGFR组（相对降低，分别为：64％（HR：0.36;95％CI：0.15-0.83）vs50％（HR：0.50;95％CI：0.28-0.90）和52％（HR：0.48;95％CI：0.21-1.13）（相互作用的P=0.646）。在所有eGFR组中，prasgurel降低的缺血性风险并不显著（HR：1.18[95％CI：0.47-2.98]，HR：0.95[95%CI：0.53-1.69]，和HR：0.61[95%CI：0.26-1.39]）（交互作用的P=0.119）。
UNASSIGNED：在接受PCI的急性冠脉综合征患者中，无论基线肾功能如何，普拉格雷剂量降低都是有益的。
UNASSIGNED：本研究评估了基于普拉格雷的降阶梯策略在肾功能受损患者中的疗效和安全性。
未经评估：我们对HOST-REDUCE-POLYTECH-ACS研究进行了事后分析。将具有估计肾小球滤过率（eGFR）的患者（n=2,311）分为3组。(高eGFR:>90mL/min;中等eGFR:60至90mL/min;和低eGFR:<60mL/min)。终点是出血结果（出血学术研究联盟2型或更高），缺血性结局(心血管死亡，心肌梗塞,支架内血栓形成,反复血运重建,和缺血性中风)，和1年随访时的净不良临床事件（包括任何临床事件）。
未经评估：无论基线肾功能如何，普拉格雷降阶梯都是有益的（相互作用的P=0.508）。低eGFR组的普拉格雷降低出血风险的相对降低高于中eGFR组和高eGFR组（相对降低，分别为：64％（HR：0.36;95％CI：0.15-0.83）vs50％（HR：0.50;95％CI：0.28-0.90）和52％（HR：0.48;95％CI：0.21-1.13）（相互作用的P=0.646）。在所有eGFR组中，prasgurel降低的缺血性风险并不显著（HR：1.18[95％CI：0.47-2.98]，HR：0.95[95%CI：0.53-1.69]，和HR：0.61[95%CI：0.26-1.39]）（交互作用的P=0.119）。
UNASSIGNED：在接受PCI的急性冠脉综合征患者中，无论基线肾功能如何，普拉格雷剂量降低都是有益的。
