Background
A personalized antiplatelet therapy guided by a novel platelet function testing (PFT), PL-12, is considered an optimized treatment strategy in stable coronary artery disease (CAD) patients undergoing PCI. However, the safety and efficacy of any dual antiplatelet therapy (DAPT) strategy may differ in relation to diabetes status. The aim of this study was to compare the outcomes of PFT-guided personalized DAPT in stable CAD patients with and without diabetes mellitus.
Methods and results
The PATH-PCI trial randomized 2285 stable CAD patients to either personalized antiplatelet therapy or standard antiplatelet treatment. We investigated the association and interaction of diabetes on clinical outcomes across two treatment groups. We did not find significant difference between the personalized group and the standard group in net adverse clinical events either in diabetes patients (10.3% vs. 13.4%, P=0.224) or in non-diabetic group (3.1% vs. 5.0%, P=0.064). In diabetes patients (n=646, 28.3%), the overall ischemic event rates were significantly low (6.8% vs. 11.3%, HR=0.586, 95%CI: 0.344-0.999, P=0.049) and the bleeding event rates did not differ between the two groups (3.5% vs. 3.3%, HR=1.066, 95%CI: 0.462-2.458, P=0.882). Similarly, in non-diabetic patients, the overall ischemic event rates were significantly low (1.8% vs. 4.2%, HR=0.428, 95%CI: 0.233-0.758, P=0.006) and the bleeding event rates did not differ between the two groups (1.6% vs. 0.9%, HR=1.802, 95%CI: 0.719-4.516, P=0.209).
Conclusions
The present study suggests that personalized antiplatelet therapy according to PFT can reduce ischemic events but not increase bleedings in stable CAD patients with or without diabetes who underwent PCI.