Impact of renal function on adverse bleeding events associated with dual antiplatelet therapy in patients with acute coronary syndrome.

It is believed, but not well established, that renal dysfunction increases the risk of adverse bleeding events associated with dual antiplatelet therapy (DAPT), especially in patients with acute coronary syndrome (ACS). The aim of this study is to estimate the impact of renal function on adverse bleeding events associated with DAPT in patients with ACS. A total of 1,264 ACS patients who received DAPT, clopidogrel (n = 530) or prasugrel (n = 734) in addition to aspirin, were assessed in a multicenter observational study. The relationship between renal function and bleeding event, defined as BARC 3 or 5, was determined using a marginal effect from the logit model and Royston-Parmar model. During an average 313.1 days of the observation period, defined as the duration of DAPT after admission until the implementation of a change in the regimen, bleeding events were observed in 7.4% of patients (n = 94). The estimated curves demonstrated that the probability of bleeding was positive correlated with renal dysfunction (6.0 to 8.6), regardless of the DAPT regimen used. This probability was consistently higher in clopidogrel (7.4 to 10.5) than in prasugrel (4.8 to 0.7). This trend was also shown in maintenance hemodialysis patients (6.7 vs. 10.3). Estimated cumulative incidences among individual stages of renal function were drawn. In conclusion, bleeding events increased with worsening renal function, and prasugrel is safer than clopidogrel as a component of DAPT throughout all levels of renal function, including hemodialysis patients after ACS.

Simple percutaneous coronary intervention strategy with a novel guide extension catheter through a 5-Fr guiding catheter for a tortuous coronary artery.

A 78-year-old female diagnosed with effort angina underwent coronary angiography. The findings revealed subtotal occlusion in the tortuous circumflex. The lesion was initially treated with a drug-coated balloon alone; however, restenosis occurred after 2 months. Thus, percutaneous coronary intervention was performed again using a drug-eluting stent (DES) through a 5-Fr guiding catheter to minimize invasiveness. However, it was not possible to pass the lesion with the DES; thus, a novel guide extension catheter with a rapid exchange system was passed under balloon anchoring against the tortuous artery. The use of this guide extension catheter resulted in the successful delivery and implantation of the DES. This approach, using a novel guide extension catheter with a rapid exchange system through a 5-Fr guiding catheter, may facilitate the implantation of devices. Learning objective: Smaller guiding catheter (GC) using a 5-Fr contributes less invasive percutaneous coronary intervention (PCI) procedure for patients. However, sometimes GC stability and device pushability become insufficient in using 5-Fr GC. Hence, we report a case of PCI procedure through a 5-Fr GC with novel guide extension catheter, and it may be an alternative option when GC stability and device pushability are insufficient. It is meaningful to share this method of PCI procedure for all physicians.