TY - JOUR
T1 - On-Treatment Platelet Reactivity and Ischemic Outcomes in Patients With Diabetes Mellitus
T2 - Two-Year Results From ADAPT-DES
AU - Shahim, Bahira
AU - Redfors, Björn
AU - Stuckey, Thomas D.
AU - Liu, Mengdan
AU - Zhou, Zhipeng
AU - Witzenbichler, Bernhard
AU - Weisz, Giora
AU - Rinaldi, Michael J.
AU - Neumann, Franz Josef
AU - Metzger, D. Christopher
AU - Henry, Timothy D.
AU - Cox, David A.
AU - Duffy, Peter L.
AU - Brodie, Bruce R.
AU - Srdanovic, Iva
AU - Madhavan, Mahesh V.
AU - Mazzaferri, Ernest L.
AU - Mehran, Roxana
AU - Ben-Yehuda, Ori
AU - Kirtane, Ajay J.
AU - Stone, Gregg W.
N1 - Publisher Copyright:
© 2022 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
PY - 2023/1/3
Y1 - 2023/1/3
N2 - BACKGROUND: Diabetes mellitus and high platelet reactivity (HPR) on clopidogrel are both associated with increased risk of ischemic events after percutaneous coronary intervention, but whether the HPR-associated risk of adverse ischemic events differs by diabetes mellitus status is unknown. METHODS AND RESULTS: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, mul-ticenter registry of patients treated with coronary drug-eluting stents. HPR was defined as P2Y12 reaction units >208 by the VerifyNow point-of-care assay. Cox multivariable analysis was used to assess whether HPR-associated risk of major adverse cardiac events (MACE; cardiac death, myocardial infarction, or stent thrombosis) varied for patients with insulin-treated diabetes mellitus (ITDM), non– ITDM, and no diabetes mellitus. Diabetes mellitus and HPR were included in an interaction analysis. Of 8582 patients enrolled, 2429 (28.3%) had diabetes mellitus, of whom 998 (41.1%) had ITDM. Mean P2Y12 reaction units were higher in patients with diabetes mellitus versus without diabetes mellitus, and HPR was more frequent in patients with diabetes mellitus. HPR was associated with consistently increased 2-year rates of MACE in patients with and without diabetes mellitus (Pinteraction =0.36). A significant interaction was present between HPR and non– insulin-treated diabetes mellitus versus ITDM for 2-year MACE (adjusted hazard ratio [HR] for non– ITDM, 2.28 [95% CI, 1.39– 3.73] versus adjusted HR for ITDM, 1.02 [95% CI, 0.70–1.50]; Pinteraction =0.01). CONCLUSIONS: HPR was more common in patients with diabetes mellitus and was associated with an increased risk of MACE in both patients with and without diabetes mellitus. In patients with diabetes mellitus, a more pronounced effect of HPR on MACE was present in lower-risk non– ITDM patients than in higher-risk patients with ITDM. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT00638794; Unique identifier: NCT00638794. ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents).
AB - BACKGROUND: Diabetes mellitus and high platelet reactivity (HPR) on clopidogrel are both associated with increased risk of ischemic events after percutaneous coronary intervention, but whether the HPR-associated risk of adverse ischemic events differs by diabetes mellitus status is unknown. METHODS AND RESULTS: ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, mul-ticenter registry of patients treated with coronary drug-eluting stents. HPR was defined as P2Y12 reaction units >208 by the VerifyNow point-of-care assay. Cox multivariable analysis was used to assess whether HPR-associated risk of major adverse cardiac events (MACE; cardiac death, myocardial infarction, or stent thrombosis) varied for patients with insulin-treated diabetes mellitus (ITDM), non– ITDM, and no diabetes mellitus. Diabetes mellitus and HPR were included in an interaction analysis. Of 8582 patients enrolled, 2429 (28.3%) had diabetes mellitus, of whom 998 (41.1%) had ITDM. Mean P2Y12 reaction units were higher in patients with diabetes mellitus versus without diabetes mellitus, and HPR was more frequent in patients with diabetes mellitus. HPR was associated with consistently increased 2-year rates of MACE in patients with and without diabetes mellitus (Pinteraction =0.36). A significant interaction was present between HPR and non– insulin-treated diabetes mellitus versus ITDM for 2-year MACE (adjusted hazard ratio [HR] for non– ITDM, 2.28 [95% CI, 1.39– 3.73] versus adjusted HR for ITDM, 1.02 [95% CI, 0.70–1.50]; Pinteraction =0.01). CONCLUSIONS: HPR was more common in patients with diabetes mellitus and was associated with an increased risk of MACE in both patients with and without diabetes mellitus. In patients with diabetes mellitus, a more pronounced effect of HPR on MACE was present in lower-risk non– ITDM patients than in higher-risk patients with ITDM. REGISTRATION: URL: https://clinicaltrials.gov/ct2/show/NCT00638794; Unique identifier: NCT00638794. ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents).
KW - diabetes mellitus
KW - drug-eluting stent
KW - percutaneous coronary intervention
KW - platelet reactivity
UR - http://www.scopus.com/inward/record.url?scp=85145491716&partnerID=8YFLogxK
U2 - 10.1161/JAHA.122.026482
DO - 10.1161/JAHA.122.026482
M3 - Article
C2 - 36565189
AN - SCOPUS:85145491716
SN - 2047-9980
VL - 12
JO - Journal of the American Heart Association
JF - Journal of the American Heart Association
IS - 1
M1 - e026482
ER -