Key result
Diabetes linked to ~73% higher MACE risk during ticagrelor monotherapy after short DAPT.
Why the study?
The adverse clinical outcomes associated with ticagrelor monotherapy after a short course of DAPT with ticagrelor and aspirin post-PCI in patients with versus without diabetes mellitus remained to be clarified.
Does ticagrelor monotherapy after a short course of DAPT following PCI have different cardiovascular and bleeding outcomes in patients with versus without diabetes mellitus?
Meta-Analysis (n=22,574)
Does ticagrelor monotherapy after a short course of DAPT following PCI have different cardiovascular and bleeding outcomes in patients with versus without diabetes mellitus?
Relative Risk: 1.73 (95% CI 1.49–2)
Absolute Event Rate: 5.68% vs 3.75%
p-value: p=0.00001
In patients receiving ticagrelor monotherapy after a short course of DAPT post-PCI, diabetes mellitus remains an independent risk factor for increased adverse cardiovascular outcomes, without a significant difference in bleeding events compared to non-diabetics.
Diabetes signals higher MACE risk on ticagrelor monotherapy after short DAPT; extends evidence of residual ischemic risk in diabetic patients.
BACKGROUND: Cardiovascular disease (CVD) is one among the major causes of mortality all round the globe. Several anti-platelet regimens have been proposed following percutaneous coronary intervention (PCI). In this analysis, we aimed to show the adverse clinical outcomes associated with ticagrelor monotherapy after a short course of dual antiplatelet therapy (DAPT) with ticagrelor and aspirin following PCI in patients with versus without diabetes mellitus (DM). METHODS: Electronic databases were searched by four authors from September to November 2023. Cardiovascular outcomes and bleeding events were the endpoints of this analysis. Revman 5.4 software was used to conduct this meta-analysis. Risk ratio (RR) and 95% confidence intervals (CI) were used to represent the results which were generated. RESULTS: Three studies with a total number of 22,574 participants enrolled from years 2013 to 2019 were included in this analysis. Results of this analysis showed that DM was associated with significantly higher risks of major adverse cardiovascular events (RR: 1.73, 95% CI: 1.49 - 2.00; P = 0.00001), all-cause mortality (RR: 2.15, 95% CI: 1.73 - 2.66; P = 0.00001), cardiac death (RR: 2.82, 95% CI: 1.42 - 5.60; P = 0.003), stroke (RR: 1.78, 95% CI: 1.16 - 2.74; P = 0.009), myocardial infarction (RR: 1.63, 95% CI: 1.17 - 2.26; P = 0.004) and stent thrombosis (RR: 1.74, 95% CI: 1.03 - 2.94; P = 0.04) when compared to patients without DM. However, thrombolysis in myocardial infarction (TIMI) defined minor and major bleedings, bleeding defined according to the academic research consortium (BARC) type 3c (RR: 1.31, 95% CI: 0.14 - 11.90; P = 0.81) and BARC type 2, 3 or 5 (RR: 1.17, 95% CI: 0.85 - 1.62; P = 0.34) were not significantly different. CONCLUSION: In patients who were treated with ticagrelor monotherapy after a short course of DAPT with ticagrelor and aspirin, DM was an independent risk factor for the significantly increased adverse cardiovascular outcomes. However, TIMI and BARC defined bleeding events were not significantly different in patients with versus without DM.
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Ning et al. (2024) conducted a meta-analysis in Percutaneous coronary intervention (n=22,574). Diabetes mellitus vs. Patients without diabetes mellitus was evaluated on Major adverse cardiovascular events (MACEs) (RR 1.73, 95% CI 1.49-2.00, p=0.00001). In patients treated with ticagrelor monotherapy after a short course of dual antiplatelet therapy following percutaneous coronary intervention, diabetes mellitus was associated with a significantly higher risk of major adverse cardiovascular events (RR 1.73).
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