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Observational Study
. 2025 Mar 24;18(6):720-733.
doi: 10.1016/j.jcin.2024.12.002.

Diabetic Status and Thrombogenicity: Association and Prognostic Implications After Percutaneous Coronary Intervention

Sungsoo Cho  1 , Moonki Jung  2 , Jong-Hwa Ahn  3 , Min Gyu Kang  4 , Jae Seok Bae  3 , Jin-Sin Koh  4 , Seok-Jae Hwang  4 , Hwi Seung Kim  5 , Sang-Wook Kim  2 , Jin-Yong Hwang  6 , Young-Hoon Jeong  7
Affiliations
Free article
Observational Study

Diabetic Status and Thrombogenicity: Association and Prognostic Implications After Percutaneous Coronary Intervention

Sungsoo Cho et al. JACC Cardiovasc Interv. .
Free article

Abstract

Background: A heightened prothrombotic environment, combined with premature and more aggressive atherosclerosis, contributes to the elevated cardiovascular risk in patients with diabetes mellitus (DM).

Objectives: The aim of this study was to evaluate the association between DM status and thrombogenicity and their prognostic implications in patients with significant coronary artery disease.

Methods: A total of 2,501 patients with coronary artery disease undergoing percutaneous coronary intervention, with on-admission glycated hemoglobin and thrombogenicity indexes (measured by thromboelastography). Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, myocardial infarction, or stroke within 4-year follow-up.

Results: Patients with DM (n = 970 [38.8%]) demonstrated significantly higher platelet-fibrin clot strength (PFCS), as indicated by maximal amplitude (median [Q1-Q3]: 67.1 [62.2-72.2] mm vs. 65.5 [61.0-70.4] mm; P < 0.001), and reduced fibrinolytic activity, measured by lysis at 30 minutes (median [Q1-Q3]: 0.1% [0.0%-1.0%] vs. 0.2% [0.0%-1.3%]; P = 0.003), compared to patients without DM. PFCS level was closely related with diabetic status, showing a positive relationship with glycated hemoglobin level up to 7.0% and then reaching a plateau. In a multivariable analysis, high PFCS phenotype defined as maximal amplitude ≥68 mm (HR: 1.39; 95% CI: 1.07-1.81; P = 0.015) and DM phenotype (HR: 1.38; 95% CI: 1.05-1.79; P = 0.018) were independently associated with MACE occurrence. The presence of diabetic phenotype and high PFCS exhibited an additive effect on MACE occurrence (HR: 2.49; 95% CI: 1.77-3.51; P < 0.001).

Conclusions: In percutaneous coronary intervention-treated patients, diabetic status and clot-strength value were significantly correlated. High clot-strength phenotype increased the risk for MACE, irrespective of diabetic phenotype. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529).

Keywords: cardiovascular event; clot strength; coronary artery disease; diabetes mellitus; percutaneous coronary intervention.

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Conflict of interest statement

Funding Support and Author Disclosures This research was supported by the Chung-Ang University Research Grants in 2022. The content is solely the responsibility of the authors and does not necessarily represent the official views of any funding agencies. The sponsors played no role in this study. There was no industry involvement in the design or conduct of the study; the collection, management, analysis, and interpretation of the data; the preparation, review, and approval of the manuscript; or the decision to submit the manuscript for publication. Dr Jeong has received honoraria for lectures from Daiichi-Sankyo, Sanofi, Han-mi Pharmaceuticals, and Daewoong Pharmaceuticals; and has received research grants or support from Samjin Pharmaceuticals, Hanmi Pharmaceuticals, Yuhan Pharmaceuticals, Biotronik Korea, and U&I Corporation. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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