ABSTRACT
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.
Subject(s)
Acute Coronary Syndrome/therapy , Diabetes Mellitus/drug therapy , Graft Occlusion, Vascular/epidemiology , Hemorrhage/epidemiology , Platelet Aggregation , Thrombosis/epidemiology , Ticlopidine/analogs & derivatives , Acute Coronary Syndrome/complications , Aged , Clopidogrel , Diabetes Mellitus/blood , Female , Follow-Up Studies , Graft Occlusion, Vascular/blood , Graft Occlusion, Vascular/etiology , Hemorrhage/blood , Hemorrhage/etiology , Humans , Incidence , Male , Platelet Aggregation Inhibitors/adverse effects , Platelet Aggregation Inhibitors/therapeutic use , Platelet Function Tests , Poland/epidemiology , Prospective Studies , Thrombosis/blood , Thrombosis/etiology , Ticlopidine/adverse effects , Ticlopidine/therapeutic useABSTRACT
BACKGROUND: Prolonged total ischaemic time (TIT) has been shown to independently predict poor myocardial perfusion in STEMI patients and affect in-hospital mortality. We aim to evaluate the influence of TIT on long-term follow-up (F/U) and identify the factors associated with TIT in patients with STEMI treated with pPCI at a high volume centre. METHODS: In a prospective "all-comer" registry, clinical, angiographic and procedural characteristics, TIT and 9-year mortality were determined in consecutive STEMI patients treated with pPCI. Patients were divided according to TIT into three groups: A) <3, B) 3-6 and C) >6h. RESULTS: Among 1064 patients, TIT was known in 1002 patients, 5 patients were lost to F/U. For censored observations F/U was 7.2-8.8 years. There were 350, 461, and 186 patients in groups A, B, and C, respectively. Patients in group A compared to B and C were younger, more often males and smokers, less frequently had history of CAD, and more frequently had occluded infarct related artery. However, final TIMI3 was obtained more frequently. Overall 30-day mortality was 4%, one-year mortality 7% and nine-year mortality 27%. Multivariable logistic regression models indicated that longer TIT was associated with a higher risk of 9-year mortality (A-21%, B-28%, C-37%, p<0.0005). TIT>6h was independently associated with advanced age, diabetes mellitus, history of CAD and higher rate of initial TIMI grade flow 3. CONCLUSIONS: TIT is strongly related with mortality in STEMI patients even after nine years of F/U. This finding reinforces the necessity of shortening the TIT in all STEMI patients.
