Impact of dual antiplatelet therapy duration after percutaneous coronary intervention on outcomes in acute coronary syndrome patients with and without chronic kidney disease: a nationwide cohort study

Abstract

Abstract Dual antiplatelet therapy (DAPT) after percutaneous coronary intervention (PCI) reduces thrombotic risk in acute coronary syndrome (ACS) but may increase bleeding, especially in chronic kidney disease (CKD). This study evaluated the impact of different DAPT durations on cardiovascular and bleeding outcomes in ACS patients with and without CKD. Using the Taiwan National Health Insurance Research Database (2001–2018), patients ≥20 years with ACS who underwent PCI and received clopidogrel plus aspirin for ≥1 month were analyzed. Primary outcomes were cardiovascular events and bleeding events. Subgroup analysis was conducted by CKD status, which was defined using claims-based International Classification of Diseases, Ninth and Tenth Revision (ICD-9/ICD-10) diagnostic codes. Among 4,800 patients with ACS identified (median age: 62 years; 77% male), there were no significant differences in cardiovascular events across DAPT duration groups. No associations between DAPT duration and cardiovascular outcomes were identified in patients with or without CKD. However, DAPT duration ≥7 months was associated with a higher incidence of other major bleeding in patients with CKD (adjusted odds ratio [aOR] = 29.7, 95% confidence interval [CI]: 1.80–491.05, p = 0.018). In patients undergoing PCI for ACS, no clear association was observed between longer DAPT duration and reduced cardiovascular events. In prespecified subgroup analyses, prolonged DAPT was associated with a higher incidence of bleeding events among patients with claims-defined CKD; however, this finding should be interpreted as exploratory given the observational design and low event rates. These results highlight the importance of individualized decision-making regarding DAPT duration, particularly in patients with increased bleeding susceptibility.