Diabetes and Outcomes Following Personalized Antiplatelet Therapy in Coronary Artery Disease Patients Who Have Undergone PCI

Abstract

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.

Epidemiology and current management of cardiovascular disease in China

“…[37] A multi-center, randomized, double-blind, triple-dummy, dose-exploring phase II trial evaluated the effect and safety of novel antiplatelet prodrug vicagrel in patients with CAD. [38] The study proved that vicagrel had comparable antiplatelet efficacy (inhibition of platelet aggregation rate) and safety (plasma concentration of metabolite and bleeding) to clopidogrel in patients with CAD undergoing PCI.…”

Current Strategies to Guide the Antiplatelet Therapy in Acute Coronary Syndromes

“…Among them, GRAVITAS [125] and TRIGGER-PCI studies [129] were focused on HTPR patients randomized to different antiplatelet therapies, whereas the others included patients with or without HTPR then randomized to PFT-guided or standard therapy. Notably, as already mentioned, TROPICAL-ACS met the non-inferiority hypothesis on net cardiac outcomes with no benefit on bleeding, and PATH-PCI met the superiority hypothesis on net adverse cardiac events with no advantage on bleeding [124,145]. However, the findings of these two clinical trials were criticized for some methodological approaches [146].…”

Association of hemoglobin glycation index with clinical outcomes in patients with coronary artery disease: A prospective cohort study

“…The details of the design have been registered on http://Clinicaltrials.gov (Identi er: NCT05174143). In this study, we enrolled 15 250 CAD patients who had a de nitive diagnosis using coronary angiography and underwent PCI as described previously [14]. We excluded the patients with sever heart failure, malignant tumor, hematologic diseases, congenital heart disease, rheumatic heart disease, valvular heart disease, serious dysfunction of liver or kidney and missing data of HbA1c and fasting plasma glucose (FPG).…”