Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention: a GReek AntiPlatElet registry substudy.

Abstract

BACKGROUND AND AIMS:

We compared the clinical outcome of diabetic versus nondiabetic patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in the GReek AntiPlatElet (GRAPE) registry.

PATIENTS AND METHODS:

GRAPE is a prospective observational study, focusing on contemporary antiplatelet use in moderate-risk to high-risk ACS patients receiving PCI. Major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and bleeding events (Bleeding Academic Research Consortium definition) at 1 year of follow-up were analyzed using propensity score adjustment. A subanalysis according to diabetes mellitus (DM) status was performed.

RESULTS:

Out of 2047 registered patients, 469 (22.9%) were diabetic. Complete 1-year follow-up was available in 95.1% of patients. MACE occurred in 12.2 and 7.2% of those patients with and without DM, respectively [adjusted hazard ratio (HR), 95% confidence interval (CI)=1.27 (0.89-1.79), P=0.2]. Observed BARC type ≥3 bleeding risk was not higher in diabetic patients: adjusted HR (95% CI)=1.20 (0.79-1.84). In the subgroup of clopidogrel-treated patients (N=238), MACE rate was significantly higher in diabetic compared with nondiabetic cohort [13.4 vs. 9%, adjusted HR (95% CI)=1.68 (1.07-2.64), P=0.03]. In the subgroup of ticagrelor-treated or prasugrel-treated patients (N=228), MACE rate did not differ significantly between diabetic and nondiabetic patients: 9.6 versus 5%, adjusted HR (95% CI)=1.35 (0.77-2.37), P=0.38.

CONCLUSION:

In 'real-life' ACS undergoing PCI, diabetic patients have higher - although not significantly - MACE rate and no difference in bleeding events. This difference in MACE was significant among clopidogrel-treated patients, whereas when newer antiplatelet agents were used the negative impact of DM on ischemic events was eliminated.

• Authors: Michalis Hamilos, Stylianos Petousis, Ioanna Xanthopoulou, John Goudevenos, John Kanakakis, George Sitafidis, Manolis Vavouranakis, Emmanuel Skalidis, George Kochiadakis, John Lekakis, Panos E Vardas, Dimitrios Alexopoulos
• Journal: Coronary artery disease (Coron Artery Dis) Vol. 29 Issue 1 Pg. 53-59 (Jan 2018) ISSN: 1473-5830 [Electronic] England
• PMID: 28834792 (Publication Type: Journal Article, Observational Study)

Chemical References

• Platelet Aggregation Inhibitors
• Clopidogrel
• Prasugrel Hydrochloride
• Ticagrelor
• Adenosine
• Ticlopidine

Topics

• Acute Coronary Syndrome (therapy)
• Adenosine (analogs & derivatives, therapeutic use)
• Aged
• Case-Control Studies
• Clopidogrel
• Cohort Studies
• Comorbidity
• Diabetes Mellitus (epidemiology)
• Female
• Greece (epidemiology)
• Hemorrhage (epidemiology)
• Humans
• Male
• Middle Aged
• Mortality
• Myocardial Infarction (epidemiology)
• Myocardial Revascularization (statistics & numerical data)
• Percutaneous Coronary Intervention (methods)
• Platelet Aggregation Inhibitors (therapeutic use)
• Prasugrel Hydrochloride (therapeutic use)
• Propensity Score
• Proportional Hazards Models
• Prospective Studies
• Stroke (epidemiology)
• Ticagrelor
• Ticlopidine (analogs & derivatives, therapeutic use)