%0 Journal Article
%T Prasugrel-Based De-Escalation in Patients With Acute Coronary Syndrome According to Renal Function.
%A Yun JP
%A Kang J
%A Park KW
%A Park K
%A Hwang D
%A Han JK
%A Yang HM
%A Kang HJ
%A Koo BK
%A Chae IH
%A Moon KW
%A Park HW
%A Won KB
%A Jeon DW
%A Han KR
%A Choi SW
%A Ryu JK
%A Jeong MH
%A Kim HS
%J JACC Asia
%V 3
%N 1
%D Feb 2023
%M 36873753
暂无%R 10.1016/j.jacasi.2022.09.013
%X <B>UNASSIGNED: </B>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).<BR><B>UNASSIGNED: </B>This study assessed the efficacy and safety of a prasugrel-based de-escalation strategy in patients with impaired renal function.<BR><B>UNASSIGNED: </B>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.<BR><B>UNASSIGNED: </B>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).<BR><B>UNASSIGNED: </B>In patients with acute coronary syndrome receiving PCI, prasugrel dose de-escalation was beneficial regardless of the baseline renal function.