Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome

Abstract

BackgroundPlatelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an acute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group. The aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding.MethodsInto this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of ADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC curve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The other (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet Reactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier curves.ResultsThe risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for either cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49–61.1; P = 0.002). Cardiovascular mortality was also higher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05–54.58; P = 0.005). We did not find a clear relation of increased clopidogrel response to the risk of bleeding.ConclusionsThe results of this study show that in diabetic ACS patient group treated with PCI an impaired platelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death.

Factors related to on-treatment platelet aggregation assessed by multiple electrode aggregometry in percutaneous coronary intervention patients on clopidogrel and aspirin

“…In our study we did not find a relation of renal function to HPR or HAR, similarly to some authors [ 43 ], yet unlike other data, including our earlier study in a different cohort [ 44 – 47 ], possibly due to a low percentage of patients with significantly impaired renal function (eGFR below 30 ml/min/1.73 m 2 ). We have also recently documented that diabetic ACS patients have a higher risk of HPR-related stent thrombosis and death [ 48 ]. However, in the present study, ACS occurrence was not independently linked to HPR.…”

Factors Impacting Stent Thrombosis in Patients With Percutaneous Coronary Intervention and Coronary Stenting: A Systematic Review and Meta-Analysis

“…The technical factors for ST include under-sized stents and bivalirudin therapy [ 33 ]. The impaired platelet responses of diabetic ACS patients with PCI also elevate their predisposition to ST [ 34 ]. These factors require a comprehensive assessment to further explore the ST attribution of baseline characteristics of PCI patients.…”

Гострий Тромбоз Стента При Інфаркті Міокарда, Ускладненому Кардіогенним Шоком, За Наявності Цукрового Діабету 2-Го Типу

“…Ці особи мають вищий кардіоваскулярний ризик розвитку серцево-судинних ускладнень, що пов'язано з ендотеліальною дисфункцією, схильністю до гіперкоагуляції і, як наслідок, тенденцією до вазоконстрикції, запальних реакцій та порушень гемостазу. Існують також дані, що в цієї категорії пацієнтів спостерігається підвищена адгезивність тромбоцитів і збільшена концентрація тканинного активатора плазміногену (ТАП) [12][13][14]. У них виникає зазвичай більш генералізований коронаросклероз, що призводить до тяжчого перебігу ГКС і частішого виникнення ТС.…”