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Multicenter Study
. 2023 Jan 3;12(1):e026482.
doi: 10.1161/JAHA.122.026482. Epub 2022 Dec 24.

On-Treatment Platelet Reactivity and Ischemic Outcomes in Patients With Diabetes Mellitus: Two-Year Results From ADAPT-DES

Bahira Shahim  1   2   3 , Björn Redfors  1   4   5 , Thomas D Stuckey  6 , Mengdan Liu  1 , Zhipeng Zhou  1 , Bernhard Witzenbichler  7 , Giora Weisz  1   8 , Michael J Rinaldi  9 , Franz-Josef Neumann  10 , D Christopher Metzger  11 , Timothy D Henry  12   13 , David A Cox  14 , Peter L Duffy  15 , Bruce R Brodie  6 , Iva Srdanovic  1 , Mahesh V Madhavan  1   4 , Ernest L Mazzaferri Jr  16 , Roxana Mehran  1   17 , Ori Ben-Yehuda  1   2 , Ajay J Kirtane  1   2 , Gregg W Stone  17
Affiliations
Multicenter Study

On-Treatment Platelet Reactivity and Ischemic Outcomes in Patients With Diabetes Mellitus: Two-Year Results From ADAPT-DES

Bahira Shahim et al. J Am Heart Assoc. .

Abstract

Background Diabetes mellitus and high platelet reactivity (HPR) on clopidogrel are both associated with increased risk of ischemic events after percutaneous coronary intervention, but whether the HPR-associated risk of adverse ischemic events differs by diabetes mellitus status is unknown. Methods and Results ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents) was a prospective, multicenter registry of patients treated with coronary drug-eluting stents. HPR was defined as P2Y12 reaction units >208 by the VerifyNow point-of-care assay. Cox multivariable analysis was used to assess whether HPR-associated risk of major adverse cardiac events (MACE; cardiac death, myocardial infarction, or stent thrombosis) varied for patients with insulin-treated diabetes mellitus (ITDM), non-ITDM, and no diabetes mellitus. Diabetes mellitus and HPR were included in an interaction analysis. Of 8582 patients enrolled, 2429 (28.3%) had diabetes mellitus, of whom 998 (41.1%) had ITDM. Mean P2Y12 reaction units were higher in patients with diabetes mellitus versus without diabetes mellitus, and HPR was more frequent in patients with diabetes mellitus. HPR was associated with consistently increased 2-year rates of MACE in patients with and without diabetes mellitus (Pinteraction=0.36). A significant interaction was present between HPR and non-insulin-treated diabetes mellitus versus ITDM for 2-year MACE (adjusted hazard ratio [HR] for non-ITDM, 2.28 [95% CI, 1.39-3.73] versus adjusted HR for ITDM, 1.02 [95% CI, 0.70-1.50]; Pinteraction=0.01). Conclusions HPR was more common in patients with diabetes mellitus and was associated with an increased risk of MACE in both patients with and without diabetes mellitus. In patients with diabetes mellitus, a more pronounced effect of HPR on MACE was present in lower-risk non-ITDM patients than in higher-risk patients with ITDM. Registration URL: https://clinicaltrials.gov/ct2/show/NCT00638794; Unique identifier: NCT00638794. ADAPT-DES (Assessment of Dual Antiplatelet Therapy With Drug-Eluting Stents).

Keywords: diabetes mellitus; drug‐eluting stent; percutaneous coronary intervention; platelet reactivity.

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Figures

Figure 1
Figure 1. Major adverse cardiac events during 2‐year follow‐up after primary percutaneous coronary intervention according to platelet reactivity on clopidogrel and diabetes mellitus status.
DM indicates diabetes mellitus; HPR, high platelet reactivity; ITDM, insulin‐treated diabetes mellitus; and NITDM, non–insulin‐treated diabetes mellitus.
Figure 2
Figure 2. Kaplan‐Meier time to first rates in patients with vs without diabetes mellitus according to platelet reactivity on clopidogrel.
A, Major adverse cardiac events. B, Death. C, Myocardial infarction. D, Stent thrombosis. E, Clinically relevant bleeding. DM indicates diabetes mellitus; and HPR, high platelet reactivity.
Figure 3
Figure 3. Kaplan‐Meier time to first rates in patients with insulin‐treated diabetes mellitus vs non–insulin‐treated diabetes mellitus according to platelet reactivity on clopidogrel.
A, Major adverse cardiac events. B, Death. C, Myocardial infarction. D, Stent thrombosis. E, Clinically relevant bleeding. HPR indicates high platelet reactivity; ITDM, insulin‐treated diabetes mellitus; and NITDM, non–insulin‐treated diabetes mellitus.
See this image and copyright information in PMC

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