Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome
| Autor: | Krzysztof Kukuła, Paweł Bekta, Adam Witkowski, Mariusz Kłopotowski, Artur Debski, Paweł K. Kunicki, Jacek Jamiołkowski, Magdalena Polańska-Skrzypczyk, Zbigniew Chmielak |
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| Rok vydání: | 2016 |
| Předmět: |
Male
medicine.medical_specialty Acute coronary syndrome Ticlopidine Platelet Aggregation Platelet Function Tests Stent thrombosis Hemorrhage 030204 cardiovascular system & hematology 03 medical and health sciences 0302 clinical medicine Diabetes mellitus Internal medicine Diabetes Mellitus Medicine Humans Platelet 030212 general & internal medicine cardiovascular diseases Prospective Studies Angiology Aged business.industry Proportional hazards model Incidence Diabetes Graft Occlusion Vascular Thrombosis medicine.disease Clopidogrel Cardiac surgery Conventional PCI Cardiology Coronary intervention Female Poland Cardiology and Cardiovascular Medicine business Platelet Aggregation Inhibitors medicine.drug Follow-Up Studies Research Article |
| Zdroj: | BMC Cardiovascular Disorders |
| ISSN: | 1471-2261 |
| Popis: | Background Platelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an acute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group. The aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding. Methods Into this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of ADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC curve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The other (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet Reactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier curves. Results The risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for either cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49–61.1; P = 0.002). Cardiovascular mortality was also higher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05–54.58; P = 0.005). We did not find a clear relation of increased clopidogrel response to the risk of bleeding. Conclusions The results of this study show that in diabetic ACS patient group treated with PCI an impaired platelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death. |
| Databáze: | OpenAIRE |
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