Bleeding risk following percutaneous coronary intervention in patients with diabetes prescribed dual anti-platelet therapy - 18/04/17
, Suzanne V. Arnold, MD, MHA a, b, Tracy Y. Wang, MD, MSc c, Praneet Sharma, MD a, b, Kensey Gosch, MS a, Philip G. Jones, MS a, Deepak L. Bhatt, MD, MPH d, Philippe Gabriel Steg, MD e, Darren K. McGuire, MD, MHSc g, David J. Cohen, MD, MSc a, b, John A. Spertus, MD, MPH a, b, Adnan K. Chhatriwalla, MD a, b, Marcus Lind, MD, PhD h, Garth Graham, MD, MPH f, Mikhail Kosiborod, MD a, bAbstract |
Background |
Patients with diabetes mellitus (DM) experience higher rates of in-stent restenosis and greater benefit from drug-eluting stents implant at the time of percutaneous coronary intervention (PCI), necessitating prolonged dual anti-platelet therapy (DAPT). While DAPT reduces risk of ischemic events post-PCI, it also increases risk of bleeding. Whether bleeding rates differ among patients with and without DM, receiving long-term DAPT is unknown.
Methods |
Among patients who underwent PCI and were maintained on DAPT for 1 year in a multicenter US registry, we assessed patient-reported bleeding over one year following PCI in patients with and without DM. Multivariable, hierarchical Poisson regression was used to evaluate the association of DM with bleeding during follow-up.
Results |
Among 2334 PCI patients from 10 US hospitals (mean age 64, 54% ACS), 32.6% had DM. In unadjusted analyses, patients with DM had fewer bleeding events over the year following PCI (DM vs no DM: BARC = 1: 78.0% vs 87.7%, P < .001; BARC ≥2: 4.3% vs 5.3%, P = .33). Following adjustment, patients with (vs without DM) had a lower risk of BARC ≥1 bleeding during follow-up (relative risk [RR] 0.89, 95% CI 0.83–0.96). This decreased bleeding risk persisted after removing bruising from the endpoint definition.
Conclusions |
In a real-world PCI registry, patients with DM experienced lower risk of bleeding risk on DAPT. As patients with DM also derive greater ischemic benefit from drug-eluting stents, which requires prolonged DAPT, our findings suggest that the balance between benefit and risk of this therapeutic approach may be even more favorable in patients with DM than previously considered.
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| Funding source: The Outcomes of PCI Study (OPS) was supported by an American Heart Association Outcomes Research Center grant (0875149N) and the Personalized Risk Information Services Manager™ (PRISM) study was supported by a grant from the National Heart Lung and Blood Institute (R01-HL096624). Dr. Grodzinsky is supported by a T32 training grant from the NHLBI (HL110837). The funding agencies had no role in data collection, analysis, interpretation or the decision to submit the results. The content is solely the responsibility of the authors and does not necessarily represent the official views of the funding agencies. |
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| Warren J. Cantor, MD served as guest editor for this article. |
Vol 182
P. 111-118 - décembre 2016 Retour au numéro
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