Platelet Reactivity and Clinical Outcomes After Drug-Eluting Stent Implantation in East Asian Patients With Diabetes: Results From the PTRG-DES Registry

초록

Background:Diabetes mellitus (DM) is associated with thrombogenicity, clinically manifested by thromboembolic events after percutaneous cutaneous intervention (PCI). This study aimed to investigate the association between DM and platelet reactivity, and clinical outcomes according to DM and high platelet reactivity (HPR) in an East Asian population.Methods:The PTRG-DES (Platelet function and genoType-Related long-term proGnosis in DES-treated patients) consortium is multicenter prospective registry to determine the relationship between platelet reactivity/genotyping and clinical outcomes in East Asian patients with coronary artery disease following PCI. Consecutive patients were successfully treated with DES and the platelet function test, using the VerifyNow assay (Accriva) was performed during dual antiplatelet therapy following PCI.Results:Between July 9, 2003, and Aug 7, 2018, 13,160 patients were enrolled at 32 academic hospitals and the result of the VerifyNow P2Y12 assay was available in 11,714 patients. The platelet reactivity of patients with DM was significantly higher than that of non-diabetic patients (DM vs non-DM: 226.0 ± 77.5 P2Y12 reactivity units [PRU] vs 213.2 ± 79.0 PRU, P < 0.001). In clinical outcomes, the MACCE rate of patients with diabetes was higher than that of patients without diabetes (DM vs non-DM: 8.8% vs 5.8%, P value <0.001). We categorized patients into four groups based on the presence or absence of DM or HPR, and the highest rate of major adverse cardiac and cerebrovascular events (MACCE) was found in patients with diabetes with HPR (adjusted hazard ratio 1.550, P value <0.001, 95% confidence interval 1.270-1.892) and no significant difference was observed between the DM without HPR group and the non-DM with HPR group during the 10-year follow-up.Conclusion:Platelet reactivity was enhanced in patients with diabetes, and HPR was an independent risk factor for MACCE in patients with DM. This analysis from PTRG-DES registry, which included a large East Asian population, demonstrated that HPR was an independent risk factor for MACCE in patients with diabetes.