Diabetes was not associated with increased cardiovascular death, MI, or stent thrombosis at 1 year versus non-diabetes in HBR patients on 1-month DAPT after PCI (HR 0.81; 95% CI 0.34-1.91; p=0.62).
Cohort (n=436)
Does 1-month DAPT result in similar rates of cardiovascular death, myocardial infarction, or stent thrombosis in diabetic versus non-diabetic high bleeding risk patients undergoing PCI?
A 1-month DAPT regimen after BP-EES implantation is feasible in high bleeding risk patients with diabetes, yielding similar ischemic and bleeding outcomes as in non-diabetic patients.
Effect estimate: HR 0.81 (95% CI 0.34-1.91)
Absolute Event Rate: 5.6% vs 4.5%
p-value: p=0.62
Abstract Introduction A shortened dual antiplatelet therapy (DAPT) is indicated in patients at a high bleeding risk (HBR) who undergo percutaneous coronary intervention (PCI), but currently limited knowledge exists on the impact of diabetes on clinical outcomes in these patients. Purpose This study aims to evaluate the association between diabetes and clinical outcomes in patients at HBR who underwent PCI with biodegradable-polymer everolimus-eluting stent (BP-EES) and subsequently followed a short 1-month DAPT strategy. Methods The POEM trial enrolled HBR patients undergoing PCI with BP-EES and subsequently treated with 1-month DAPT. In this prespecified subgroup analysis we assessed diabetes-associated outcomes according to the intention-to-treat principle. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or definite/probable stent thrombosis at 1 year. Time-to-event outcomes were analyzed using the Kaplan-Meier method and log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models. Results 436 patients were included in the analysis, of whom 166 (38.1%) had diabetes. The primary endpoint occurred in 5.6% in the diabetes group and 4.5% in the non-diabetes group (HR 0.81, 95% CI 0.34-1.91, p=0.62). Similar rates were observed for secondary ischemic endpoints. Bleeding rates were 3.8% and 5.3%, respectively (HR 1.38, 95% CI 0.53-3.59, p=0.51). Conclusions Our analysis demonstrated no significant increase in clinical outcomes associated with diabetes, as well as similar ischemic and bleeding rates as non-diabetic patients. These findings support a short DAPT regimen as a feasible strategy after PCI in diabetic patients with HBR.
Gramss et al. (Sun,) conducted a cohort in High bleeding risk undergoing percutaneous coronary intervention (n=436). Diabetes vs. Non-diabetes was evaluated on Composite of cardiovascular death, myocardial infarction, or definite/probable stent thrombosis at 1 year (HR 0.81, 95% CI 0.34-1.91, p=0.62). Diabetes was not associated with increased cardiovascular death, MI, or stent thrombosis at 1 year versus non-diabetes in HBR patients on 1-month DAPT after PCI (HR 0.81; 95% CI 0.34-1.91; p=0.62).