What is the clinical evidence from this study?

Study design: Observational. Population: Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=2047). Intervention: Diabetes mellitus vs. Nondiabetic patients. Primary outcome: Major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) (HR 1.27, 95% CI 0.89-1.79, p=0.2).

What does this research mean for the field?

In patients with acute coronary syndrome undergoing percutaneous coronary intervention, diabetes mellitus is associated with a non-significant increase in 1-year major adverse cardiovascular events compared to non-diabetics, though this risk is significantly elevated when patients are treated with clopidogrel rather than newer antiplatelet agents. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To compare clinical outcomes of diabetic versus nondiabetic patients with acute coronary syndrome undergoing PCI.

August 23, 2017Coronary Artery Disease

Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention

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Key result

Diabetes mellitus was associated with a non-significant increase in 1-year MACE compared to non-diabetics in patients with ACS undergoing PCI (12.2% vs 7.2%; HR 1.27; 95% CI 0.89-1.79; P=0.2).

Why the study?

Does diabetes mellitus increase the risk of MACE in moderate-to-high risk ACS patients undergoing PCI on contemporary antiplatelet therapy?

Population

2,047 moderate-risk to high-risk acute coronary syndrome patients undergoing percutaneous coronary…

Comparison

Contemporary antiplatelet therapy in patients… vs Contemporary antiplatelet therapy in patients…

Design

Cohort

Follow-up

1 year

Authors

MHMichalis HamilosInterventional Cardiology SPStylianos PetousisUniversity of Crete IXIoanna XanthopoulouGeneral University Hospital of Patras

Discussion

Member takes

Implication

Diabetics show nonsignificantly higher MACE post-PCI for ACS with similar bleeding; leaves open whether diabetes independently drives risk in contemporary regimens.

Key Points

To compare clinical outcomes of diabetic versus nondiabetic patients with acute coronary syndrome undergoing PCI.
Prospective observational study from the GReek AntiPlatElet (GRAPE) registry
Analyzed major adverse cardiovascular events and bleeding events at 1 year post-PCI
Subanalysis by diabetes status with propensity score adjustment.
MACE occurred in 12.2% of diabetic patients compared to 7.2% in nondiabetic patients (HR 1.27, CI 0.89-1.79, P=0.2)
In clopidogrel-treated patients, MACE rate was significantly higher in diabetics (13.4% vs. 9%, HR 1.68, CI 1.07-2.64, P=0.03)
No significant difference in MACE rates among ticagrelor/prasugrel-treated patients (9.6% vs. 5%, HR 1.35, CI 0.77-2.37, P=0.38).

Study Design

Type

Observational (n=2,047)

Structured PICO

Does diabetes mellitus increase the risk of MACE in moderate-to-high risk ACS patients undergoing PCI on contemporary antiplatelet therapy?

Population

2,047 moderate-risk to high-risk patients with acute coronary syndrome undergoing percutaneous coronary intervention, followed for 1 year.

Exposure

Contemporary antiplatelet therapy (clopidogrel, ticagrelor, or prasugrel) in patients with diabetes mellitus.

Comparator

Contemporary antiplatelet therapy in patients without diabetes mellitus.

Outcome

Major adverse cardiovascular events (MACE), defined as a composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke at 1 year of follow-up.composite

Main Result

Hazard Ratio: 1.27 (95% CI 0.89–1.79)

Absolute Event Rate: 12.2% vs 7.2%

p-value: p=0.2

In ACS patients undergoing PCI, the use of newer antiplatelet agents (ticagrelor or prasugrel) appears to eliminate the excess ischemic risk associated with diabetes that is observed with clopidogrel.

Cite This Study

Hamilos et al. (2017) conducted an observational in Acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) (n=2,047). Diabetes mellitus vs. Nondiabetic patients was evaluated on Major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) (HR 1.27, 95% CI 0.89-1.79, p=0.2). Diabetes mellitus was associated with a non-significant increase in 1-year MACE compared to non-diabetics in patients with ACS undergoing PCI (12.2% vs 7.2%; HR 1.27; 95% CI 0.89-1.79; P=0.2).

synapsesocial.com/papers/6a62a197fcd714155f09852c https://doi.org/10.1097/mca.0000000000000547

Topics

Dual antiplatelet therapy Percutaneous coronary intervention

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Implication

Diabetics show nonsignificantly higher MACE post-PCI for ACS with similar bleeding; leaves open whether diabetes independently drives risk in contemporary regimens.

Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Topics

Antiplatelet treatment in diabetic patients with acute coronary syndrome undergoing percutaneous coronary intervention

Discussion

Member takes

Implication

Key Points

Study Design

Structured PICO

Main Result

Cite This Study

Also Consider

Topics

Also Consider