Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus

Renato Valenti, Giulia Cantini, Rossella Marcucci, Marco Marrani, Angela Migliorini, Nazario Carrabba, Vincenzo Comito, Ruben Vergara, Giampaolo Cerisano, Guido Parodi, Rosanna Abbate, Anna Maria Gori, Gian Franco Gensini, David Antoniucci

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Abstract

Background The study sought to determine the impact of high residual platelet reactivity (HRPR) on long-term cardiac mortality in diabetic patients treated with PCI for CTO. No data exist about the impact of HRPR after 600 mg clopidogrel loading on long-term clinical outcome in patients with diabetes mellitus and treated with percutaneous coronary angioplasty (PCI) for chronic total occlusion (CTO). Methods From the Florence CTO-PCI registry, we identified consecutive diabetic patients with available in vitro platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. HRPR was defined as residual platelet aggregation by 10 μmol/L ADP test ≥ 70%. The primary end point of the study was long-term cardiac mortality. Results Two-hundred and three diabetic patients underwent CTO-PCI. The incidence of HRPR was 23%. The 3-year cardiac survival was lower in the HRPR group than the low residual platelet reactivity (LRPR) group (70 ± 7% and 92 ± 3%, respectively; p = 0.001). Within the oral antidiabetic patients there were no significant differences in long-term survival between HRPR and LRPR groups. Conversely, the association of insulin therapy and HRPR was related to a dramatic decrease in survival compared to the LRPR group (34 ± 14% vs. 89 ± 4%; p <0.001). At multivariable analysis insulin therapy (HR 4.31; p = 0.001) and HRPR (HR 3.26; p = 0.004) were significantly related to long-term mortality, while completeness of revascularization was inversely related to cardiac mortality (HR 0.40; p = 0.029). Conclusion HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.

Original languageEnglish
Pages (from-to)561-567
Number of pages7
JournalInternational Journal of Cardiology
Volume201
DOIs
Publication statusPublished - Oct 10 2015

Fingerprint

Percutaneous Coronary Intervention
Diabetes Mellitus
Blood Platelets
Angioplasty
clopidogrel
Mortality
Coronary Occlusion
Survival
Insulin
Platelet Aggregation
Hypoglycemic Agents
Adenosine Diphosphate
Registries

Keywords

  • Coronary occlusion
  • Diabetes mellitus
  • Platelet reactivity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus. / Valenti, Renato; Cantini, Giulia; Marcucci, Rossella; Marrani, Marco; Migliorini, Angela; Carrabba, Nazario; Comito, Vincenzo; Vergara, Ruben; Cerisano, Giampaolo; Parodi, Guido; Abbate, Rosanna; Gori, Anna Maria; Gensini, Gian Franco; Antoniucci, David.

In: International Journal of Cardiology, Vol. 201, 10.10.2015, p. 561-567.

Research output: Contribution to journalArticle

Valenti, R, Cantini, G, Marcucci, R, Marrani, M, Migliorini, A, Carrabba, N, Comito, V, Vergara, R, Cerisano, G, Parodi, G, Abbate, R, Gori, AM, Gensini, GF & Antoniucci, D 2015, 'Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus', International Journal of Cardiology, vol. 201, pp. 561-567. https://doi.org/10.1016/j.ijcard.2015.04.052
Valenti, Renato ; Cantini, Giulia ; Marcucci, Rossella ; Marrani, Marco ; Migliorini, Angela ; Carrabba, Nazario ; Comito, Vincenzo ; Vergara, Ruben ; Cerisano, Giampaolo ; Parodi, Guido ; Abbate, Rosanna ; Gori, Anna Maria ; Gensini, Gian Franco ; Antoniucci, David. / Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus. In: International Journal of Cardiology. 2015 ; Vol. 201. pp. 561-567.
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title = "Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus",
abstract = "Background The study sought to determine the impact of high residual platelet reactivity (HRPR) on long-term cardiac mortality in diabetic patients treated with PCI for CTO. No data exist about the impact of HRPR after 600 mg clopidogrel loading on long-term clinical outcome in patients with diabetes mellitus and treated with percutaneous coronary angioplasty (PCI) for chronic total occlusion (CTO). Methods From the Florence CTO-PCI registry, we identified consecutive diabetic patients with available in vitro platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. HRPR was defined as residual platelet aggregation by 10 μmol/L ADP test ≥ 70{\%}. The primary end point of the study was long-term cardiac mortality. Results Two-hundred and three diabetic patients underwent CTO-PCI. The incidence of HRPR was 23{\%}. The 3-year cardiac survival was lower in the HRPR group than the low residual platelet reactivity (LRPR) group (70 ± 7{\%} and 92 ± 3{\%}, respectively; p = 0.001). Within the oral antidiabetic patients there were no significant differences in long-term survival between HRPR and LRPR groups. Conversely, the association of insulin therapy and HRPR was related to a dramatic decrease in survival compared to the LRPR group (34 ± 14{\%} vs. 89 ± 4{\%}; p <0.001). At multivariable analysis insulin therapy (HR 4.31; p = 0.001) and HRPR (HR 3.26; p = 0.004) were significantly related to long-term mortality, while completeness of revascularization was inversely related to cardiac mortality (HR 0.40; p = 0.029). Conclusion HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.",
keywords = "Coronary occlusion, Diabetes mellitus, Platelet reactivity",
author = "Renato Valenti and Giulia Cantini and Rossella Marcucci and Marco Marrani and Angela Migliorini and Nazario Carrabba and Vincenzo Comito and Ruben Vergara and Giampaolo Cerisano and Guido Parodi and Rosanna Abbate and Gori, {Anna Maria} and Gensini, {Gian Franco} and David Antoniucci",
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T1 - Prognostic impact of high residual platelet reactivity after chronic total occlusion percutaneous coronary intervention in patients with diabetes mellitus

AU - Valenti, Renato

AU - Cantini, Giulia

AU - Marcucci, Rossella

AU - Marrani, Marco

AU - Migliorini, Angela

AU - Carrabba, Nazario

AU - Comito, Vincenzo

AU - Vergara, Ruben

AU - Cerisano, Giampaolo

AU - Parodi, Guido

AU - Abbate, Rosanna

AU - Gori, Anna Maria

AU - Gensini, Gian Franco

AU - Antoniucci, David

PY - 2015/10/10

Y1 - 2015/10/10

N2 - Background The study sought to determine the impact of high residual platelet reactivity (HRPR) on long-term cardiac mortality in diabetic patients treated with PCI for CTO. No data exist about the impact of HRPR after 600 mg clopidogrel loading on long-term clinical outcome in patients with diabetes mellitus and treated with percutaneous coronary angioplasty (PCI) for chronic total occlusion (CTO). Methods From the Florence CTO-PCI registry, we identified consecutive diabetic patients with available in vitro platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. HRPR was defined as residual platelet aggregation by 10 μmol/L ADP test ≥ 70%. The primary end point of the study was long-term cardiac mortality. Results Two-hundred and three diabetic patients underwent CTO-PCI. The incidence of HRPR was 23%. The 3-year cardiac survival was lower in the HRPR group than the low residual platelet reactivity (LRPR) group (70 ± 7% and 92 ± 3%, respectively; p = 0.001). Within the oral antidiabetic patients there were no significant differences in long-term survival between HRPR and LRPR groups. Conversely, the association of insulin therapy and HRPR was related to a dramatic decrease in survival compared to the LRPR group (34 ± 14% vs. 89 ± 4%; p <0.001). At multivariable analysis insulin therapy (HR 4.31; p = 0.001) and HRPR (HR 3.26; p = 0.004) were significantly related to long-term mortality, while completeness of revascularization was inversely related to cardiac mortality (HR 0.40; p = 0.029). Conclusion HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.

AB - Background The study sought to determine the impact of high residual platelet reactivity (HRPR) on long-term cardiac mortality in diabetic patients treated with PCI for CTO. No data exist about the impact of HRPR after 600 mg clopidogrel loading on long-term clinical outcome in patients with diabetes mellitus and treated with percutaneous coronary angioplasty (PCI) for chronic total occlusion (CTO). Methods From the Florence CTO-PCI registry, we identified consecutive diabetic patients with available in vitro platelet reactivity assessment by light transmittance aggregometry after a loading dose of 600 mg of clopidogrel. HRPR was defined as residual platelet aggregation by 10 μmol/L ADP test ≥ 70%. The primary end point of the study was long-term cardiac mortality. Results Two-hundred and three diabetic patients underwent CTO-PCI. The incidence of HRPR was 23%. The 3-year cardiac survival was lower in the HRPR group than the low residual platelet reactivity (LRPR) group (70 ± 7% and 92 ± 3%, respectively; p = 0.001). Within the oral antidiabetic patients there were no significant differences in long-term survival between HRPR and LRPR groups. Conversely, the association of insulin therapy and HRPR was related to a dramatic decrease in survival compared to the LRPR group (34 ± 14% vs. 89 ± 4%; p <0.001). At multivariable analysis insulin therapy (HR 4.31; p = 0.001) and HRPR (HR 3.26; p = 0.004) were significantly related to long-term mortality, while completeness of revascularization was inversely related to cardiac mortality (HR 0.40; p = 0.029). Conclusion HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.

KW - Coronary occlusion

KW - Diabetes mellitus

KW - Platelet reactivity

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