Key result
The combination of diabetes, SYNTAX score ≥15, and high platelet reactivity in NSTE-ACS patients undergoing PCI was associated with a 16.4% one-year MACE rate, compared to <3% in those with SS <15.
Why the study?
How do diabetes mellitus, high platelet reactivity, and SYNTAX score interact to affect one-year clinical outcomes in patients with NSTE-ACS undergoing PCI?
Observational (n=1,042)
How do diabetes mellitus, high platelet reactivity, and SYNTAX score interact to affect one-year clinical outcomes in patients with NSTE-ACS undergoing PCI?
The combination of diabetes, a SYNTAX score ≥15, and high platelet reactivity identifies a very high-risk cohort of NSTE-ACS patients post-PCI who may benefit from more potent P2Y12 inhibition.
High-risk NSTE-ACS cohort post-PCI warrants validation; leaves open whether potent P2Y12 inhibition improves outcomes.
AIMS: In patients with non-ST-elevation acute coronary syndromes (NSTE-ACS) treated with PCI, high (H) platelet reactivity (PR) significantly affects one-year outcome. The aim of this report was to analyse the relationships between HPR, the SYNTAX score (SS) and one-year major adverse cardiac events (MACE: cardiac death, myocardial infarction, stent thrombosis) according to diabetes mellitus (DM) status in patients included in the GEne Polymorphism, Platelet REactivity, and the Syntax Score (GEPRESS) study. METHODS AND RESULTS: PR was measured using the vasodilator-stimulated phosphoprotein (VASP) assay at three time points (before PCI, at hospital discharge and at one month after PCI), with HPR defined as >50% PR index in 1,042 patients treated with aspirin and clopidogrel for one year after PCI. Patients with DM and an SS ≥15 had the highest MACE rate between one month and one year, further increased by the presence of HPR (16.4%). On the other hand, among all patients with an SS <15, MACE rates remained low (<3%), irrespective of DM status and PR. CONCLUSIONS: Among NSTE-ACS patients treated with PCI, the combination of DM, an SS ≥15 and HPR characterised a cohort with the highest MACE rate from one month to one year. In such high-risk patients, careful clinical monitoring and implementation of secondary prevention measures, including the use of potent P2Y12 inhibitors, are strongly advised.
No takes yet. Share an insight, caveat, or question.
Servi et al. (2016) conducted an observational in non-ST-segment elevation acute coronary syndrome (NSTE-ACS) (n=1,042). Diabetes mellitus, SYNTAX score ≥15, and high platelet reactivity vs. SYNTAX score <15 was evaluated on One-year major adverse cardiac events (cardiac death, myocardial infarction, stent thrombosis). The combination of diabetes, SYNTAX score ≥15, and high platelet reactivity in NSTE-ACS patients undergoing PCI was associated with a 16.4% one-year MACE rate, compared to <3% in those with SS <15.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: