Benefits and Risks of Prolonged Duration Dual Antiplatelet Therapy (Clopidogrel and Aspirin) After Percutaneous Coronary Intervention in High-Risk Patients With Diabetes Mellitus

Wang, Haoyu; Cai, Zhongxing; Yin, Dong; Yang, Yuejin; Song, Weihua; Dou, Kefei

doi:10.1016/j.amjcard.2020.11.043

Cited by 3 publications

(4 citation statements)

References 29 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The antiplatelet duration may have an impact on the effect of coronary collateralization for patients with T2DM. Many studies have found that DAPT prolongation resulted in significant reduction in the risk of ischemic events [22][23][24] . Notably, T2DM significantly increases the risk of CTO, emerging as a crucial independent factor associated with elevated rates of cardiovascular mortality and repeat revascularization post CTO-PCI [25][26] .…”

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

Wang,

Zhang,

Zhai

et al. 2024

Cardiology Plus

View full text Add to dashboard Cite

Background and purpose: Chronic total occlusion (CTO) lesions commonly affect elderly patients, especially those with type 2 diabetes mellitus (T2DM), often associated with coronary collaterals (CC). However, it remains unclear whether CC influences the prognosis of CTO. This retrospective single-center study aimed to evaluate the prognostic relevance of CC in elderly patients with T2DM after successful revascularization for CTO. Methods: We analyzed data from 416 patients diagnosed with CTO who underwent successful revascularization between January 2013 and January 2017. Patients were categorized into two groups: the Non-T2DM group and T2DM group. Subgroup analyses were performed based on the status of CC. The primary outcome was the occurrence of major adverse cardiac events (MACE) during the follow-up period, with the secondary outcomes including all-cause mortality, cardiac death, and repeat revascularization. Results: CC did not significantly impact clinical endpoints in the overall elderly patient population. However, we observed a lower incidence of MACE, cardiac death, all-cause mortality, and repeat revascularization in the Non-T2DM group compared to the T2DM group. In patients without T2DM, poor-CC was associated with higher rates of all-cause mortality (9% vs. 18%, P = 0.041), an increased risk of cardiac death (5% vs. 12%, P = 0.042), and a greater incidence of MACE (15% vs. 28%, P = 0.031), whereas no such associations were observed in T2DM patients. Furthermore, in multivariate Cox analysis, T2DM emerged as an independent factor influencing the time to MACE (adjusted hazard ratio [HR]:1.847, 95% confidence interval [95% CI]: 1.215–2.810, P = 0.004) and repeat revascularization (adjusted HR: 2.093, 95% CI: 1.310–3.344, P = 0.002) in elderly CTO patients, rather than coronary collateralization. Notably, regardless of the quality of CC, elderly patients with T2DM exhibited a poorer prognosis. Conclusions: Elderly patients without T2DM derived greater long-term survival benefits from successful revascularization of CTO compared to those with T2DM. Additionally, good collateralization was associated with a decreased risk of adverse clinical outcomes specifically in Non-T2DM patients.

show abstract

Section: Discussionmentioning

confidence: 99%

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

Wang,

Zhang,

Zhai

et al. 2024

Cardiology Plus

View full text Add to dashboard Cite

show abstract

“…14 Several studies focussed on the efficacy and safety of prolonged DAPT in these high-risk patients, with contradicting results. [33][34][35] The ADAPT-DES study assessed bleeding rates in a large cohort of close to 9000 patients undergoing PCI, who were treated with DAPT using clopidogrel for at least 1 year. The observed bleeding rate at 30 days and 2 years follow-up was 0.7% and 8.8%, respectively.…”

Section: Discussionmentioning

confidence: 99%

“…Apart from an increased risk of reoccurring thrombotic events, diabetic patients are more prone to major bleeding, refraining clinicians from administering more potent antiplatelet therapies in diabetic patients 14 . Several studies focussed on the efficacy and safety of prolonged DAPT in these high‐risk patients, with contradicting results 33‐35 . The ADAPT‐DES study assessed bleeding rates in a large cohort of close to 9000 patients undergoing PCI, who were treated with DAPT using clopidogrel for at least 1 year.…”

Section: Discussionmentioning

confidence: 99%

Short‐term dual antiplatelet therapy in diabetic patients admitted for acute coronary syndrome treated with a new‐generation drug‐eluting stent

Vranken

Rasoul

Luijkx

et al. 2022

Diabetes Metabolism Res

View full text Add to dashboard Cite

Background:The optimal duration of dual antiplatelet therapy (DAPT) in patients with diabetes mellitus (DM) admitted with acute coronary syndrome (ACS) and treated with a drug-eluting stent (DES) remains unclear. This is a prespecified substudy from the Randomised Evaluation of short-term DUal antiplatelet therapy in patients with acute Coronary syndromE treated with a new generation DES (REDUCE) trial that was designed to determine the efficacy and safety of short-term versus standard 12 months DAPT in diabetic patients with ACS undergoing percutaneous coronary intervention (PCI) using the COMBO stent. Methods:In this study we included ACS diabetic patients enroled in the REDUCE trial treated with the COMBO stent and randomly assigned to either 3 or 12 months of DAPT. The primary study endpoint was the composite of all-cause mortality, myocardial infarction (MI), stent thrombosis (ST), stroke, target vessel revascularisation (TVR), and bleeding complications at 12 and 24 months follow-up.Results: A total of 307 diabetic patients were included, of which 162 (52.8%) in the 3 months DAPT group and 145 (47.2%) in the 12 months DAPT group. Patient characteristics, PCI success, and number of stents used were similar in the 3 and 12 months DAPT groups. Occurrence of the primary study endpoint at 12 and 24 months follow-up was comparable between the two groups (3.1 vs. 3.5%, p = 0.865, and 15.8 vs. 14.9%, p = 0.824, respectively). Moreover, the prevalence of the specific clinical outcome parameters (all-cause mortality), MI, ST, stroke, TVR, and bleeding was similar in both study groups.Conclusions: This sub-analysis shows similar clinical outcomes following 3 months DAPT as compared to 12 months DAPT in diabetic patients undergoing PCI for ACS This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

show abstract

“…An individualized approach, relying on current clinical guidelines, and applying the appropriate risk scores is needed when deciding on the need for prolonged DAPT. Clinicians are best placed in identifying patients at higher risk of ischaemic events and a low bleeding risk ( 10 , 11 ).…”

Section: Introductionmentioning

confidence: 99%

Duration and clinical outcomes of dual antiplatelet therapy following percutaneous coronary intervention for acute coronary syndrome: A multicentre “real-world practice” registry-based study

Vergara-Uzcategui

Moreno

Hennessey

et al. 2023

Front. Cardiovasc. Med.

View full text Add to dashboard Cite

BackgroundThe optimal duration of dual antiplatelet therapy (DAPT) ought to be determined taking into account individual ischaemic or bleeding events risks. To date, studies have provided inconclusive evidence on the effects of prolonged DAPT. We sought to evaluate the long-term outcomes of this strategy following percutaneous revascularization in the context of acute coronary syndrome (ACS).MethodsRetrospectively from four centers in Madrid, we identified 750 consecutive ACS patients, divided in two groups of DAPT duration: <13 months and >13 months, with a mean follow-up of 48 months.ResultsPatients with DAPT > 13 months had a higher non-adjusted incidence of Major Adverse Cardiovascular Events (11.6% vs. 17.3%) and new revascularization (3.7% vs. 8.7%). Differences in all-cause death, cardiac death, myocardial infarction, stent thrombosis and stroke were non-significant. There was no difference in the incidence of major bleeding (7.4% vs. 6.3%). Multivariable Cox regression analysis showed that the independent risk predictors of MACE were age (HR: 1.04, 95% CI: 1.02–1.06, p < 0.001) and multivessel disease (HR: 2.29, 95% CI: 1.32–3.95, p = 0.003), whereas the independent protective predictor was normal hemoglobin (HR: 0.88, 95% CI: 0.78–0.98, p = 0.022).ConclusionsIn this real-world registry cohort of ACS patients treated with PCI and 1 year of DAPT in Spain, we report a trend of increased rate of MACE and new revascularization not associated with TVR in patients with longer DAPT. Our findings support the need for future randomized controlled trials to confirm or refute these results.

show abstract

Benefits and Risks of Prolonged Duration Dual Antiplatelet Therapy (Clopidogrel and Aspirin) After Percutaneous Coronary Intervention in High-Risk Patients With Diabetes Mellitus

Cited by 3 publications

References 29 publications

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

Long-term clinical outcomes in elderly patients with chronic total occlusion and type 2 diabetes: the impact of coronary collateralization following successful recanalization

Short‐term dual antiplatelet therapy in diabetic patients admitted for acute coronary syndrome treated with a new‐generation drug‐eluting stent

Duration and clinical outcomes of dual antiplatelet therapy following percutaneous coronary intervention for acute coronary syndrome: A multicentre “real-world practice” registry-based study

Contact Info

Product

Resources

About