Coronary artery diseaseComparison of Platelet Reactivity and Periprocedural Outcomes in Patients With Versus Without Diabetes Mellitus and Treated With Clopidogrel and Percutaneous Coronary Intervention
Section snippets
Methods
A total of 285 consecutive clopidogrel-treated patients undergoing elective PCI for stable angina or non–ST-elevation acute coronary syndromes were recruited. All patients received a 600-mg clopidogrel loading dose ≥6 hours before intervention or were pretreated with clopidogrel 75 mg/day for ≥5 days. Exclusion criteria were ST-elevation myocardial infarction (MI), upstream use of glycoprotein IIb/IIIa inhibitors, platelet count <70 × 109/L, high bleeding risk, coronary artery bypass surgery in
Results
One hundred four diabetic (36%) and 181 nondiabetic patients were enrolled. The main clinical and procedural features are presented in Table 1, Table 2.
Patients with DM had significantly higher platelet reactivity before PCI compared to nondiabetics (214 ± 83 vs 193 ± 68 PRU, p = 0.02). HPR was more frequently observed in diabetics versus nondiabetics (36% vs 22%, p = 0.01; Figure 1) before PCI. This association remained significant after adjustment for factors potentially related to HPR (i.e.,
Discussion
In the present study, we evaluated platelet function using the VerifyNow P2Y12 assay and found that diabetic patients have higher platelet reactivity before PCI despite adequate clopidogrel pretreatment compared to nondiabetics, in agreement with previous work. However, these data show for the first time that diabetic patients taking clopidogrel and aspirin have significantly higher rates of periprocedural MI compared to nondiabetics. Furthermore, the combination of DM and HPR despite
References (29)
- et al.
Monitoring platelet inhibition after clopidogrel with the VerifyNow-P2Y12(R) rapid analyzer: the VERIfy Thrombosis risk ASsessment (VERITAS) study
Thromb Res
(2007) - et al.
Point-of-care measurement of clopidogrel responsiveness predicts clinical outcome in patients undergoing percutaneous coronary intervention results of the ARMYDA-PRO (Antiplatelet therapy for Reduction of MYocardial Damage during Angioplasty-platelet Reactivity predicts Outcome) study
J Am Coll Cardiol
(2008) - et al.
Prognostic significance of periprocedural versus spontaneously occurring myocardial infarction after percutaneous coronary intervention in patients with acute coronary syndromes: an analysis from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial
J Am Coll Cardiol
(2009) - et al.
Insulin therapy is associated with platelet dysfunction in patients with type 2 diabetes mellitus on dual oral antiplatelet treatment
J Am Coll Cardiol
(2006) - et al.
The relation between platelet reactivity and glycemic control in diabetic patients with cardiovascular disease on maintenance aspirin and clopidogrel therapy
Am Heart J
(2009) - et al.
Elevated plasma fibrinogen and diabetes mellitus are associated with lower inhibition of platelet reactivity with clopidogrel
J Am Coll Cardiol
(2008) - et al.
Impact of platelet reactivity on cardiovascular outcomes in patients with type 2 diabetes mellitus and coronary artery disease
J Am Coll Cardiol
(2007) - et al.
Clinical outcomes after detection of elevated cardiac enzymes in patients undergoing percutaneous interventionIntegrilin (eptifibatide) to Minimize platelet Aggregation and Coronary Thrombosis-II
J Am Coll Cardiol
(1999) - et al.
Mortality risk conferred by small elevations of creatine kinase-MB isoenzyme after percutaneous coronary intervention
J Am Coll Cardiol
(2003) - et al.
Adjusted clopidogrel loading doses according to vasodilator-stimulated phosphoprotein phosphorylation index decrease rate of major adverse cardiovascular events in patients with clopidogrel resistance: a multicenter randomized prospective study
J Am Coll Cardiol
(2008)
Glycoprotein IIb/IIIa inhibitors improve outcome after coronary stenting in clopidogrel nonresponders: a prospective, randomized study
JACC Cardiovasc Interv
Validation of a VerifyNow-P2Y12 cartridge for monitoring platelet inhibition with clopidogrel
Methods Find Exp Clin Pharmacol
Definition, diagnosis and classification of diabetes mellitus and its complicationsPart 1: diagnosis and classification of diabetes mellitus provisional report of a WHO consultation
Diabet Med
Universal definition of myocardial infarction
Circulation
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