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Deng Q, Hou J, Deng X, Zhong Z. Association of serum laboratory parameters with periprocedural myocardial infarction after a primary percutaneous coronary intervention. Perfusion 2023; 38:393-400. [PMID: 35038275 DOI: 10.1177/02676591211057502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Periprocedural myocardial infarction (PMI) is one of the mortality-related complications of percutaneous coronary intervention (PCI) and significantly affects short- and long-term adverse outcomes and immediate cardiovascular events. Our present study aimed to evaluate the association of preprocedural serum laboratory parameters and PMI in patients who received primary PCI and attempted to provide detailed data on the predictors of PCI-related PMI. METHODS A total of 1184 consecutive coronary artery disease (CAD) patients who received primary and elective PCI between July 2015 and June 2017 were included and divided into control group and PMI group. The data of serum laboratory parameters were collected from the electronic database of Meizhou People's Hospital. RESULTS The results indicated that preprocedural fasting blood glucose were higher in PMI group compared with the control group (p < .001). Patients with prior hyperlipidemia were more likely to have experienced PCI-related PMI (p = .018) and the preprocedural level of total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C), non-HDL-C, apolipoprotein B (Apo B), and LDL-C/high density lipoprotein cholesterol (HDL-C) were significantly enhanced in PMI group (p < .001). Multivariate regression analysis revealed that preprocedural fasting blood glucose > 6.11 mmol/L (p < .001, OR = 1.949, 95% CI: 1.444-2.630) and LDL-C levels ≥130 mg/dL (p = .005, OR = 1.941, 95% CI: 1.217-3.098) independently predicted PCI-related PMI. CONCLUSION Our results indicated preprocedural fasting blood glucose >6.11 mmol/L and LDL-C levels ≥130 mg/dL may be useful predictors for PCI-related PMI. The study may provide a detailed data on the predictors of PCI-related PMI.
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Affiliation(s)
- Qiaoting Deng
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Jingyuan Hou
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Xunwei Deng
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China
| | - Zhixiong Zhong
- Research Experimental Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China.,Guangdong Provincial Engineering and Technology Research Center for Molecular Diagnostics of Cardiovascular Diseases, Meizhou, PR China.,Guangdong Provincial Key Laboratory of Precision Medicine and Clinical Translational Research of Hakka Population, Meizhou, PR China.,Department of Cardiovascular Diseases Center, Meizhou People's Hospital (Huangtang Hospital), Meizhou, PR China
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2
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Guan S, Xu X, Li Y, Li J, Guan M, Wang X, Jing Q, Huo Y, Han Y. Impact of Diabetes Mellitus on Antithrombotic Management Patterns and Long-Term Clinical Outcomes in Patients With Acute Coronary Syndrome: Insights From the EPICOR Asia Study. J Am Heart Assoc 2020; 9:e013476. [PMID: 33164633 PMCID: PMC7763726 DOI: 10.1161/jaha.119.013476] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Long‐term use of antiplatelet agents after acute coronary syndrome in diabetic patients is not well known. Here, we describe antiplatelet use and outcomes in such patients enrolled in the EPICOR Asia (Long‐Term Follow‐up of Antithrombotic Management Patterns in Acute Coronary Syndrome Patients in Asia) registry. Methods and Results EPICOR Asia is a prospective, observational study of 12 922 patients with acute coronary syndrome surviving to discharge, from 8 countries/regions in Asia. The present analysis included 3162 patients with diabetes mellitus (DM) and 9602 patients without DM. The impact of DM on use of antiplatelet agents and events (composite of death, myocardial infarction, and stroke, with or without any revascularization; individual components, and bleeding) was evaluated. Significant baseline differences were seen between patients with DM and patients without DM for age, sex, body mass index, cardiovascular history, angiographic findings, and use of percutaneous coronary intervention. At discharge, ≈90% of patients in each group received dual antiplatelet therapy. At 2‐year follow‐up, more patients with DM tended to still receive dual antiplatelet therapy (60% versus 56%). DM was associated with increased risk from ischemic but not major bleeding events. Independent predictors of the composite end point of death, myocardial infarction, and stroke in patients with DM were age ≥65 years and use of diuretics at discharge. Conclusions Antiplatelet agent use is broadly comparable in patients with DM and patients without DM, although patients with DM are more likely to be on dual antiplatelet therapy at 2 years. Patients with DM are at increased risk of ischemic events, suggesting an unmet need for improved antithrombotic treatment. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01361386.
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Affiliation(s)
- Shaoyi Guan
- General Hospital of Northern Theater Command Shenyang China
| | - Xiaoming Xu
- General Hospital of Northern Theater Command Shenyang China
| | - Yi Li
- General Hospital of Northern Theater Command Shenyang China
| | - Jing Li
- General Hospital of Northern Theater Command Shenyang China
| | - Mingzi Guan
- General Hospital of Northern Theater Command Shenyang China
| | - Xiaozeng Wang
- General Hospital of Northern Theater Command Shenyang China
| | - Quanmin Jing
- General Hospital of Northern Theater Command Shenyang China
| | - Yong Huo
- Peking University First Hospital Beijing China
| | - Yaling Han
- General Hospital of Northern Theater Command Shenyang China
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3
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Wang Q, Yang K, Bundhun PK. Discontinuing Aspirin After Short Term Use Versus Continuous Use with a P2Y12 Inhibitor for the Treatment of Patients with Type 2 Diabetes Mellitus Following Percutaneous Coronary Intervention: A Meta-analysis. Diabetes Ther 2020; 11:2299-2311. [PMID: 32844374 PMCID: PMC7509031 DOI: 10.1007/s13300-020-00909-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION In this analysis, we aimed to compare the efficacy and safety of discontinuing aspirin (ASA) after short-term use versus its continuous use with a P2Y12 inhibitor for the treatment of patients with type 2 diabetes mellitus (T2DM) following percutaneous coronary intervention (PCI). METHODS From May to June 2020, electronic databases were searched for related publications. The cardiovascular and bleeding outcomes representing efficacy and safety, respectively, were the endpoints of this study. The new RevMan software version 5.4 was used to analyze the data. Risk ratios (RR) and 95% confidence intervals (CI) were used to represent the results following data analysis. RESULTS A total of 9774 participants with T2DM were included in this analysis, whereby 4941 patients were assigned to the ASA discontinuation group and 4833 patients to the dual antiplatelet (DAPT) group. Our result showed that compared to a longer duration (12 months) of DAPT (ASA + P2Y12 inhibitor) use in these patients with T2DM, discontinuing ASA after short-term use (1-3 months) thereafter using only a P2Y12 inhibitor (mono-therapy) was not associated with a significant increase in the risk of major adverse cardiovascular and cerebrovascular events (RR 0.92, 95% CI 0.76-1.12; P = 0.39), myocardial infarction (RR 0.98, 95% CI 0.75-1.26; P = 0.86), all-cause mortality (RR 0.78, 95% CI 0.60-1.02; P = 0.07), cardiac death (RR 0.76, 95% CI 0.43-1.35; P = 0.35), stroke (RR 1.06, 95% CI 0.67-1.67; P = 0.80) and stent thrombosis (RR 0.98, 95% CI 0.58-1.65; P = 0.93). However, discontinuing ASA after short-term use in these patients with T2DM was associated with a lower risk of bleeding defined according to the Academic Research Consortium (BARC) type 2-5 (RR 0.55, 95% CI 0.41-0.73; P = 0.0001), and thrombolysis in myocardial infarction (TIMI) defined as major (RR 0.55, 95% CI 0.41-0.75; P = 0.0001) and minor bleeding (RR 0.58, 95% CI 0.43-0.78; P = 0.0004). CONCLUSION Discontinuing ASA after short-term use for the treatment of patients with T2DM following PCI was not associated with any increased cardiovascular outcomes. Also, discontinuing ASA after short-term use and continuing the use of a P2Y12 inhibitor were somewhat safer in these patients with T2DM. Further research should follow.
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Affiliation(s)
- Qiang Wang
- Institute of Cardiovascular Diseases, Jingzhou Central Hospital, Jingzhou Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China
| | - Keping Yang
- Institute of Cardiovascular Diseases, Jingzhou Central Hospital, Jingzhou Clinical Medical College, Yangtze University, Jingzhou, Hubei, People's Republic of China.
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4
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Patti G, Cavallari I, Andreotti F, Calabrò P, Cirillo P, Denas G, Galli M, Golia E, Maddaloni E, Marcucci R, Parato VM, Pengo V, Prisco D, Ricottini E, Renda G, Santilli F, Simeone P, De Caterina R. Prevention of atherothrombotic events in patients with diabetes mellitus: from antithrombotic therapies to new-generation glucose-lowering drugs. Nat Rev Cardiol 2020; 16:113-130. [PMID: 30250166 PMCID: PMC7136162 DOI: 10.1038/s41569-018-0080-2] [Citation(s) in RCA: 70] [Impact Index Per Article: 17.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Diabetes mellitus is an important risk factor for a first cardiovascular event and for worse outcomes after a cardiovascular event has occurred. This situation might be caused, at least in part, by the prothrombotic status observed in patients with diabetes. Therefore, contemporary antithrombotic strategies, including more potent agents or drug combinations, might provide greater clinical benefit in patients with diabetes than in those without diabetes. In this Consensus Statement, our Working Group explores the mechanisms of platelet and coagulation activity, the current debate on antiplatelet therapy in primary cardiovascular disease prevention, and the benefit of various antithrombotic approaches in secondary prevention of cardiovascular disease in patients with diabetes. While acknowledging that current data are often derived from underpowered, observational studies or subgroup analyses of larger trials, we propose antithrombotic strategies for patients with diabetes in various cardiovascular settings (primary prevention, stable coronary artery disease, acute coronary syndromes, ischaemic stroke and transient ischaemic attack, peripheral artery disease, atrial fibrillation, and venous thromboembolism). Finally, we summarize the improvements in cardiovascular outcomes observed with the latest glucose-lowering drugs, and on the basis of the available evidence, we expand and integrate current guideline recommendations on antithrombotic strategies in patients with diabetes for both primary and secondary prevention of cardiovascular disease. Patients with diabetes mellitus have a prothrombotic status that increases the risk of cardiovascular events and worsens prognosis after these events. In this Consensus Statement, the Working Group on Thrombosis of the Italian Society of Cardiology proposes antithrombotic strategies for patients with diabetes in various cardiovascular settings.
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Affiliation(s)
- Giuseppe Patti
- Department of Life, Health and Environmental Sciences, University of L'Aquila, L'Aquila, Italy.
| | - Ilaria Cavallari
- Unit of Cardiovascular Science, Campus Bio-Medico University, Rome, Italy
| | - Felicita Andreotti
- Cardiovascular and Thoracic Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Paolo Calabrò
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, University Federico II, Naples, Italy
| | - Gentian Denas
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Mattia Galli
- Cardiovascular and Thoracic Department, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy
| | - Enrica Golia
- Department of Cardio-thoracic and Respiratory Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Ernesto Maddaloni
- Department of Medicine, Unit of Endocrinology and Diabetes, Campus Bio-Medico University, Rome, Italy
| | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vito Maurizio Parato
- Cardiology Unit, Madonna del Soccorso Hospital, San Benedetto del Tronto, Italy.,Politecnica Delle Marche University, San Benedetto del Tronto, Italy
| | - Vittorio Pengo
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padova, Padova, Italy
| | - Domenico Prisco
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | | | - Giulia Renda
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy
| | - Francesca Santilli
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
| | - Paola Simeone
- Department of Medicine and Aging, G. d'Annunzio University, Chieti, Italy
| | - Raffaele De Caterina
- Institute of Cardiology, G. d'Annunzio University, Chieti, Italy. .,Fondazione G. Monasterio, Pisa, Italy.
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5
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Gorbet M, Sperling C, Maitz MF, Siedlecki CA, Werner C, Sefton MV. The blood compatibility challenge. Part 3: Material associated activation of blood cascades and cells. Acta Biomater 2019; 94:25-32. [PMID: 31226478 DOI: 10.1016/j.actbio.2019.06.020] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2019] [Revised: 05/03/2019] [Accepted: 06/13/2019] [Indexed: 01/09/2023]
Abstract
Following protein adsorption/activation which is the first step after the contact of material surfaces and whole blood (part 2), fibrinogen is converted to fibrin and platelets become activated and assembled in the form of a thrombus. This thrombus formation is the key feature that needs to be minimized in the creation of materials with low thrombogenicity. Further aspects of blood compatibility that are important on their own are complement and leukocyte activation which are also important drivers of thrombus formation. Hence this review summarizes the state of knowledge on all of these cascades and cells and their interactions. For each cascade or cell type, the chapter distinguishes statements which are in widespread agreement from statements where there is less of a consensus. STATEMENT OF SIGNIFICANCE: This paper is part 3 of a series of 4 reviews discussing the problem of biomaterial associated thrombogenicity. The objective was to highlight features of broad agreement and provide commentary on those aspects of the problem that were subject to dispute. We hope that future investigators will update these reviews as new scholarship resolves the uncertainties of today.
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Affiliation(s)
- Maud Gorbet
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
| | - Claudia Sperling
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Manfred F Maitz
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Christopher A Siedlecki
- Departments of Surgery and Bioengineering, The Pennsylvania State University, College of Medicine, Hershey, PA 17033, United States
| | - Carsten Werner
- Institute Biofunctional Polymer Materials, Max Bergmann Center of Biomaterials, Leibniz-Institut für Polymerforschung Dresden e.V., Dresden, Germany
| | - Michael V Sefton
- Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario, Canada.
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6
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Patti G, Cavallari I, Antonucci E, Calabrò P, Cirillo P, Gresele P, Palareti G, Pengo V, Pignatelli P, Ricottini E, Marcucci R. Prevalence and predictors of dual antiplatelet therapy prolongation beyond one year in patients with acute coronary syndrome. PLoS One 2017; 12:e0186961. [PMID: 29059255 PMCID: PMC5653361 DOI: 10.1371/journal.pone.0186961] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2017] [Accepted: 10/10/2017] [Indexed: 12/15/2022] Open
Abstract
There are limited real-world data on prevalence and predictors of dual antiplatelet therapy (DAPT) prolongation beyond one year after acute coronary syndrome (ACS). We have explored such issue in the START ANTIPLATELET Registry, which is a prospective, observational, multicenter, Italian registry performed in seven Italian cardiology institutions including patients admitted for ACS and followed up to one year. Out of a total population of 840 ACS patients, 596 patients had completed 12-month follow-up being on DAPT. Decision to prolong DAPT beyond one year was taken in 79 patients (13%), whereas in 517 patients DAPT was stopped. The strongest predictors of DAPT continuation were a new cardiovascular events after the index admission event (OR 3.3, 95% CI 1.4-7.7), no bleeding complications (OR 3.2, 95% CI 1.2-8.3) and no anemia during one-year follow-up (OR 2.6, 95% CI 1.1-5.9); other independent predictors were renal failure (OR 2.5, 95% CI 1.3-5.0) and peripheral artery disease (OR 1.8, 95% CI 1.1-3.0). The choice of DAPT prolongation was not correlated with younger ager, presence of diabetes mellitus, coronary angioplasty as initial treatment strategy or type of implanted stent (drug-eluting vs bare metal). In conclusion, this study provides a real-world snapshot on the factors influencing the option to continue DAPT beyond one year after ACS; a low bleeding risk seems to influence the choice to prolong DAPT more than a high ischemic risk.
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Affiliation(s)
| | | | | | - Paolo Calabrò
- Division of Cardiology, Monaldi Hospital and "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Plinio Cirillo
- Department of Advanced Biomedical Sciences, School of Medicine, "Federico II" University, Naples, Italy
| | - Paolo Gresele
- Department of Medicine, Division of Internal and Cardiovascular Medicine, University of Perugia, Perugia, Italy
| | | | - Vittorio Pengo
- Department of Cardiothoracic and Vascular Sciences, University Hospital of Padua, Padua, Italy
| | - Pasquale Pignatelli
- Department of Internal Medicine and Medical Specialties, La Sapienza University of Rome, Rome, Italy
| | | | - Rossella Marcucci
- Department of Experimental and Clinical Medicine, Center for Atherothrombotic diseases, University of Florence, Florence, Italy
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7
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Dalby AJ, Gottlieb S, Cyr DD, Magnus Ohman E, McGuire DK, Ruzyllo W, Bhatt DL, Wiviott SD, Winters KJ, Fox KA, Armstrong PW, White HD, Prabhakaran D, Roe MT. Dual antiplatelet therapy in patients with diabetes and acute coronary syndromes managed without revascularization. Am Heart J 2017; 188:156-166. [PMID: 28577671 DOI: 10.1016/j.ahj.2017.03.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2016] [Accepted: 03/23/2017] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Patients with diabetes mellitus (DM) presenting with acute coronary syndrome (ACS) and undergoing percutaneous coronary intervention (PCI) derived enhanced benefit with dual antiplatelet therapy (DAPT) with prasugrel vs. clopidogrel. The risk profile and treatment response to DAPT for medically managed ACS patients with DM remains uncertain. METHODS The TRILOGY ACS trial compared aspirin + prasugrel vs. aspirin + clopidogrel for up to 30months in non-ST-segment elevation (NSTE) ACS patients managed medically without revascularization. We compared treatment-related outcomes among 3539 patients with DM vs. 5767 patients without DM. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or stroke. RESULTS Patients with vs. without DM were younger, more commonly female, heavier, and more often had revascularization prior to the index ACS event. The frequency of the primary endpoint through 30months was higher among patients with vs. without DM (24.8% vs. 16.3%), with a higher risk for those patients with DM treated with insulin vs. those treated without insulin (35.3% vs. 19.9%). There was no significant difference in the frequency of the primary endpoint by treatment with prasugrel vs. clopiodgrel in those with or without DM (Pint=0.82) and with or without insulin treatment among those with DM (Pint=0.304). CONCLUSIONS Among NSTE ACS patients managed medically without revascularization, patients with DM had a higher risk of ischemic events that was amplified among those treated with insulin. There was no differential treatment effect with a more potent DAPT regimen of aspirin + prasugrel vs. aspirin + clopidogrel.
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8
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Patti G, Di Gioia G, Cavallari I, Nenna A. Safety and efficacy of nonvitamin K antagonist oral anticoagulants versus warfarin in diabetic patients with atrial fibrillation: A study-level meta-analysis of phase III randomized trials. Diabetes Metab Res Rev 2017; 33. [PMID: 28029216 DOI: 10.1002/dmrr.2876] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2016] [Revised: 11/01/2016] [Accepted: 12/14/2016] [Indexed: 11/09/2022]
Abstract
In patients with atrial fibrillation (AF), the safety and efficacy of nonvitamin K antagonist oral anticoagulants (NOACs) vs warfarin according to diabetes mellitus (DM) status are not completely characterized. We performed a meta-analysis to clarify whether in these patients the strategy of oral anticoagulation should be tailored to diabetes status. In this study-level meta-analysis, we included 4 randomized phase III trials comparing NOACs and warfarin in patients with nonvalvular AF; a total of 18 134 patients with DM and 40 454 without DM were overall considered. Incidence of the following outcome measures was evaluated during the follow-up: stroke or systemic embolism, ischemic stroke, major bleeding, intracranial bleeding, and vascular death. Use of NOACs compared with warfarin reduced stroke/systemic embolism in diabetic (Risk Ratios [RR] 0.80, 95% CI 0.68-0.93; P = .004) and nondiabetic patients (RR 0.83, 0.73-0.93; P = .001) (P for interaction .72). No interaction between diabetes status and benefits of NOACs was found for the occurrence of ischemic stroke, major bleeding, or intracranial bleeding (P for interaction >.05 for each comparison). Reduction of vascular death rates with NOACs was significant in diabetic patients (4.97% vs 5.99% with warfarin; RR 0.83, 0.72-0.96; P = .01), in whom absolute the reduction of this outcome measure was higher than in nondiabetics (1.02% vs 0.27%), although no interaction was present (P = .23). Results of this meta-analysis support the safety and efficacy of NOACs compared with warfarin in diabetic patients with nonvalvular AF.
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Affiliation(s)
- Giuseppe Patti
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Giuseppe Di Gioia
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Ilaria Cavallari
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
| | - Antonio Nenna
- Department of Cardiovascular Sciences, Campus Bio-Medico University of Rome, Rome, Italy
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9
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Moschonas IC, Tselepis AD. Increased Benefit With Vorapaxar Use in Patients With a History of Myocardial Infarction and Diabetes Mellitus: What the Data Show Us. J Cardiovasc Pharmacol Ther 2016; 22:133-141. [PMID: 27489245 DOI: 10.1177/1074248416662347] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Type 2 diabetes mellitus (T2DM) is a progressive and multifactorial metabolic disease mainly characterized by hyperglycemia and insulin resistance. Abnormal platelet reactivity associated with an increased risk of cardiovascular disease (CVD) is also a feature characteristic of patients with T2DM. Dual antiplatelet therapy consisting of aspirin and an adenosine diphosphate platelet P2Y12 receptor antagonist, such as clopidogrel, represents the standard antithrombotic regimen for the secondary prevention of CVD risk in T2DM. However, a high proportion of patients with T2DM exhibit high on-treatment platelet reactivity to aspirin and/or clopidogrel, associated with a greater risk of adverse cardiovascular events compared with nondiabetic patients. Consequently, novel antiplatelet therapeutic approaches may be required in order to avoid such events. Vorapaxar is a novel antiplatelet agent that targets the platelet protease-activated receptor 1 and inhibits thrombin-induced platelet activation. Vorapaxar has been studied in 2 phase III clinical trials and has been approved for use in the secondary prevention of atherothrombotic events in patients with a previous myocardial infarction (MI) or peripheral arterial disease. New data from the Thrombin-Receptor Antagonist in Secondary Prevention of Atherothrombotic Ischemic Events (TRA 2°P)-TIMI 50 trial MI cohort demonstrate that the subgroup of patients with T2DM exhibits increased benefit from vorapaxar use compared with non-T2DM patients. The aim of the present work is to critically review the current knowledge concerning vorapaxar use in patients with T2DM as well as to discuss the possible mechanism(s) underlying vorapaxar's beneficial effect in T2DM.
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Affiliation(s)
- Iraklis C Moschonas
- 1 Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
| | - Alexandros D Tselepis
- 1 Atherothrombosis Research Centre/Laboratory of Biochemistry, Department of Chemistry, University of Ioannina, Ioannina, Greece
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10
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Piccolo R, Eitel I, Galasso G, Dominguez-Rodriguez A, Iversen AZ, Abreu-Gonzalez P, Windecker S, Thiele H, Piscione F. 1-Year Outcomes With Intracoronary Abciximab in Diabetic Patients Undergoing Primary Percutaneous Coronary Intervention. J Am Coll Cardiol 2016; 68:727-38. [DOI: 10.1016/j.jacc.2016.05.078] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 05/12/2016] [Accepted: 05/18/2016] [Indexed: 12/25/2022]
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11
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Rossington JA, Brown OI, Hoye A. Systematic review and meta-analysis of optimal P2Y12 blockade in dual antiplatelet therapy for patients with diabetes with acute coronary syndrome. Open Heart 2016; 3:e000296. [PMID: 27127634 PMCID: PMC4847131 DOI: 10.1136/openhrt-2015-000296] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 12/08/2015] [Accepted: 01/02/2016] [Indexed: 02/06/2023] Open
Abstract
Background Patients with diabetes are at increased risk of acute coronary syndromes (ACS) and their mortality and morbidity outcomes are significantly worse following ACS events, independent of other comorbidities. This systematic review sought to establish the optimum management strategy with focus on P2Y12 blockade in patients with diabetes with ACS. Methods MEDLINE (1946 to present) and EMBASE (1974 to present) databases, abstracts from major cardiology conferences and previously published systematic reviews were searched to June 2014. Relevant randomised control trials with clinical outcomes for P2Y12 inhibitors in adult patients with diabetes with ACS were scrutinised independently by 2 authors with applicable data was extracted for primary composite end point of cardiovascular death, myocardial infarction (MI) and stroke; enabling calculation of relative risks with 95% CI with subsequent direct and indirect comparison. Results Four studies studied clopidogrel in patients with diabetes, with two (3122 patients) having primary outcome data showing superiority of clopidogrel against placebo with RR0.84 (95% CI 0.72–0.99). Irrespective of management strategy, the newer agents prasugrel (2 studies) and ticagrelor (1 study) had a lower primary event rate compared with clopidogrel; RR 0.80 (95% CI 0.66 to 0.97) and RR 0.89 (95% CI 0.77 to 1.02), respectively. When ticagrelor was indirectly compared with prasugrel, there was a trend to an improved primary outcome with prasugrel (RR 1.11 (95% CI 0.94 to 1.31)) particularly in those managed with percutaneous coronary intervention (PCI) (RR 1.23 (95% CI 0.95 to 1.59)). Prasugrel demonstrated a statistical superiority with prevention of further MI with RR 1.48 (95% CI 1.11 to 1.97). This was not at the expense of increased major thrombolysis in MI (TIMI) bleeding rates RR 0.94 (95% CI 0.59 to 1.51). Conclusions This meta-analysis shows the addition of a P2Y12 inhibitor is superior to placebo, with a trend favouring the use of prasugrel in patients with diabetes with ACS, particularly those undergoing PCI.
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Affiliation(s)
- Jennifer A Rossington
- Department of Academic Cardiology , Hull York Medical School, Castle Hill Hospital , Cottingham, East Yorkshire , UK
| | - Oliver I Brown
- Department of Academic Cardiology , Hull York Medical School, Castle Hill Hospital , Cottingham, East Yorkshire , UK
| | - Angela Hoye
- Department of Academic Cardiology , Hull York Medical School, Castle Hill Hospital , Cottingham, East Yorkshire , UK
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12
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Higashi Y, Miyata T, Shigematsu H, Origasa H, Fujita M, Matsuo H, Naritomi H, Matsuda H, Nakajima M. Baseline Characterization of Japanese Peripheral Arterial Disease Patients – Analysis of Surveillance of Cardiovascular Events in Antiplatelet-Treated Arteriosclerosis Obliterans Patients in Japan (SEASON) –. Circ J 2016; 80:712-21. [DOI: 10.1253/circj.cj-15-1048] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Yukihito Higashi
- Department of Cardiovascular Regeneration and Medicine, Research Institute for Radiation Biology and Medicine, Hiroshima University
| | - Tetsuro Miyata
- Sanno Medical Center, International University of Health and Welfare
| | | | - Hideki Origasa
- Division of Biostatistics and Clinical Epidemiology, University of Toyama School of Medicine
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13
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Shao H, Lu J, Xu YT, Zhan Y, Chen GM, Zhang HJ. Metabolic Interaction Potential between Clopidogrel and Sulfonylurea Antidiabetic Agents: Effects on Clopidogrel Bioactivation. Pharmacology 2015; 97:18-24. [DOI: 10.1159/000441230] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2015] [Accepted: 09/22/2015] [Indexed: 11/19/2022]
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14
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Xiang L, Mittwede PN, Clemmer JS. Glucose Homeostasis and Cardiovascular Alterations in Diabetes. Compr Physiol 2015; 5:1815-39. [DOI: 10.1002/cphy.c150001] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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15
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Proscia C, Nusca A, Simona M, Rosetta M, Di Sciascio G. Platelet reactivity and antiplatelet management in diabetic patients with coronary artery disease. Interv Cardiol 2015. [DOI: 10.2217/ica.15.9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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16
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Abstract
Patients with diabetes mellitus (DM) have accelerated atherosclerosis with an increased risk for atherothrombotic cardiovascular complications. A state of high platelet reactivity and activation, hypercoagulability (prothrombotic state) and a subdued response to standard antiplatelet agents may explain high rate of adverse cardiovascular events in patients with DM. Several antithrombotic treatment strategies have been developed to control the prothrombotic state in patients with DM: dose modification of commonly used agents; use of potent agents; and addition of a third antithrombotic drug (triple therapy) to commonly prescribed dual antiplatelet therapy of aspirin and a P2Y12 inhibitor. The present review aims to provide an overview of the current knowledge on platelet abnormalities in patients with DM, focusing on the challenges and perspectives of antiplatelet treatment strategies in this population.
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Affiliation(s)
- Jung Hwa Jung
- Division of Endocrinology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
| | | | - Paul A. Gurbel
- Sinai Center for Thrombosis Research, Baltimore, MD, USA
| | - Young-Hoon Jeong
- Division of Cardiology, Department of Internal Medicine, Gyeongsang National University Hospital, Gyeongsang National University School of Medicine, Jinju, Korea
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17
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Saito S, Isshiki T, Kimura T, Ogawa H, Yokoi H, Nanto S, Takayama M, Kitagawa K, Nishikawa M, Miyazaki S, Nakamura M. Efficacy and safety of adjusted-dose prasugrel compared with clopidogrel in Japanese patients with acute coronary syndrome: the PRASFIT-ACS study. Circ J 2014; 78:1684-92. [PMID: 24759796 DOI: 10.1253/circj.cj-13-1482] [Citation(s) in RCA: 245] [Impact Index Per Article: 24.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Prasugrel is an antiplatelet agent that shows more prompt, potent, and consistent platelet inhibition than clopidogrel. The objective of this study was to confirm the efficacy and safety of prasugrel at loading/maintenance doses of 20/3.75 mg. METHODS AND RESULTS Japanese patients (n=1,363) with acute coronary syndrome undergoing percutaneous coronary intervention were randomized to either prasugrel (20/3.75 mg) or clopidogrel (300/75 mg), both in combination with aspirin (81-330 mg for the first dose and 81-100 mg/day thereafter), for 24-48 weeks. The primary efficacy endpoint was the incidence of major adverse cardiovascular events (MACE) at 24 weeks, defined as a composite of cardiovascular death, nonfatal myocardial infarction, and nonfatal ischemic stroke. We compared the incidence of MACE between the 2 groups using point estimates. Safety outcomes included the incidence of bleeding events until 2 weeks after the last dose. The incidence of MACE at 24 weeks was 9.4% in the prasugrel group and 11.8% in the clopidogrel group (risk reduction 23%, hazard ratio 0.77, 95% confidence interval 0.56-1.07). The incidence of non-coronary artery bypass graft-related major bleeding was similar in both groups (1.9% vs. 2.2%). CONCLUSIONS Prasugrel 20/3.75 mg was associated with a low incidence of ischemic events, similar to the results of TRITON-TIMI 38, and with a low risk of clinically serious bleeding in Japanese ACS patients.
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Affiliation(s)
- Shigeru Saito
- Division of Cardiology, Shonan Kamakura General Hospital
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