Long-Term Antithrombotic Therapy and Clinical Outcomes in Patients with Acute Coronary Syndrome and Renal Impairment: Insights from EPICOR and EPICOR Asia.


Huo Y(1), Van de Werf F(2), Han Y(3), Rossello X(4)(5)(6)(7), Pocock SJ(6), Chin CT(8), Lee SW(9), Li Y(10), Jiang J(11), Vega AM(12), Medina J(12), Bueno H(5)(7)(13)(14).
Author information:
(1)Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China. [Email]
(2)Department of Cardiovascular Sciences, KU, Leuven, Belgium.
(3)General Hospital of Shenyang Military Region, Shenyang, China.
(4)Health Research Institute of the Balearic Islands
(IdISBa), University Hospital Son Espases, Palma, Spain.
(5)Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain.
(6)Department of Medical Statistics, London School of Hygiene and Tropical Medicine, London, UK.
(7)Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares
(CIBERCV), Madrid, Spain.
(8)National Heart Centre Singapore, Singapore, Singapore.
(9)Queen Mary Hospital, Hong Kong SAR, China.
(10)Department of Cardiology, Shenyang Northern Hospital, Shenyang, China.
(11)Department of Cardiology, Peking University First Hospital, 8 Xishiku St., Xicheng District, Beijing, 100034, China.
(12)Medical Department, AstraZeneca, Madrid, Spain.
(13)Instituto de investigación i+12 and Cardiology Department, Hospital Universitario, 12 de Octubre, Madrid, Spain.
(14)Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.


BACKGROUND: Information is lacking on long-term management of patients with acute coronary syndrome (ACS) and chronic kidney disease (CKD) (estimated glomerular filtration rate [eGFR] < 60 mL/min/1.73 m2). OBJECTIVES: Our objectives were to describe antithrombotic management patterns and outcomes in patients with ACS with varying renal function from the EPICOR (long-tErm follow-uP of antithrombotic management patterns In acute CORonary syndrome patients; NCT01171404) and EPICOR Asia (NCT01361386) studies. METHODS: EPICOR and EPICOR Asia were prospective observational studies of patients who survived hospitalization for ACS and were enrolled at discharge in 28 countries across Europe, Latin America, and Asia. The studies were conducted from 2010 to 2013 and from 2011 to 2014, respectively. This analysis evaluated patient characteristics and oral antithrombotic management patterns and outcomes up to 2 years post-discharge according to admission eGFR: ≥ 90, 60-89, 30-59, or < 30 mL/min/1.73 m2. RESULTS: Among 22,380 patients with available data, eGFR < 60 mL/min/1.73 m2 was observed in 16.7%. Patients with poorer renal function were older, were at greater cardiovascular risk, and had more prior cardiovascular disease and bleeding. Patients with CKD underwent fewer cardiovascular interventions and had more in-hospital cardiovascular and bleeding events. Dual antiplatelet therapy was less likely at discharge in patients with eGFR < 30 (82.3%) than in those with ≥ 90 (91.3%) mL/min/1.73 m2 and declined more sharply during follow-up in patients with low eGFR (p < 0.0001). An adjusted proportional hazards model showed that patients with lower eGFR levels had a higher risk of cardiovascular events and bleeding. CONCLUSIONS: The presence of CKD in patients with ACS was associated with less aggressive cardiovascular management and an increased risk of cardiovascular events.