Optimal antiplatelet therapy in patients with acute coronary syndrome and chronic kidney disease: for the Jerusalem platelets thrombosis and intervention in cardiology (JUPITER-11) study group

Introduction: Chronic kidney disease (CKD) is a well-documented risk factor for major adverse cardiac events and bleeding events. The optimal antiplatelet strategy for patients with CKD remains unclear, especially patients with glomerular filtration rate (GFR) < 30 ml/min. We aim to compare clinical outcomes of patients with acute coronary syndrome (ACS) and CKD treated with ticagrelor or prasugrel vs. clopidogrel. Methods: Patients were collected from the acute coronary syndrome Israeli survey (ACSIS). Patients were divided into 2 groups: ST-segment myocardial infarction (STEMI) and non-STEMI. Each group was further divided based on the GFR value (<30 ml/min or ≥ 30 ml/min). Mortality, bleeding, repeat revascularization, and re-hospitalization at 30-day and 1-year were evaluated. Results: A total of 5,442 patients were included in the final analysis. There were no significant differences regarding baseline characteristics between both groups of ACS patients. In patients with STEMI and GFR < 30 ml/min, re-hospitalization (32% vs. 29 % p = 1.0), bleeding (2.7% vs 2.3% p = 0.9), and death rates (8.1 % vs 2.3% p = 0.5) did not differ between the two different treatment strategies at 30-day follow-up. The mortality rate in 1-year was lower among STEMI patients treated with the ticagrelor or prasugrel as compared with clopidogrel (33% vs 11% p = 0.04). Conclusion: In patients with ACS and CKD, rehospitalization, bleeding and mortality rates were similar in30 days in patients treated with ticagrelor/prasugrel versus clopidogrel. Nevertheless, in patients presenting with STEMI and GFR < 30 ml/min, treatment with ticagrelor/prasugrel was correlated with a lower 1-year mortality rate as compared with clopidogrel treatment with no increase in bleeding rates.