Laurent Feldman1, Florence Tubach2, Jean-Michel Juliard3, Dominique Himbert3, Grégory Ducrocq3, Emmanuel Sorbets4, Konstantinos Triantafyllou3, Arthur Kerner5, Hélène Abergel3, Marie-Geneviève Huisse6, Ronan Roussel7, Marina Esposito-Farèse8, Philippe Gabriel Steg9, Nadine Ajzenberg6. 1. Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France. Electronic address: laurent.feldman@bch.aphp.fr. 2. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE, Paris, France. 3. Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France. 4. Service de Médecine Nucléaire, AP-HP, Hôpital Bichat, Paris, France. 5. Cardiology Department, Rambam Medical Center, Haifa, Israel. 6. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France; Service d'Hémostase, AP-HP, Hôpital Bichat, Paris France. 7. Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Service de Diabétologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris France; U872, INSERM, Paris, France. 8. Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE, Paris, France. 9. Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France.
Abstract
BACKGROUND: Previous studies, which compared the prevalence of high on-clopidogrel platelet reactivity (HCPR) in type 2 diabetes mellitus (T2DM) versus non-T2DM and obese versus nonobese patients provided conflicting results. METHODS: We compared the prevalence of HCPR in patients with T2DM, metabolic syndrome (MS), or neither T2DM nor MS undergoing drug-eluting stent implantation for stable coronary artery disease. Platelet functions were measured after a 600-mg clopidogrel loading dose and after 4 months on clopidogrel 75 mg/d. RESULTS: The prevalence of HCPR was significantly higher in 63 T2DM and 50 MS patients than in 43 patients with neither T2DM nor MS (46.0% and 52.0% vs 20.9%) after clopidogrel loading dose, whereas, at 4 months, only T2DM patients had a significantly higher prevalence of HCPR (50.8% and 31.3% vs 23.8%). By multivariable analysis, T2DM (odds ratio [OR] 3.62, 95% CI, 1.34-9.80, P = .011), MS (OR 4.00, 95% CI 1.39-11.46, P = .010), and previous chronic treatment with clopidogrel (OR 0.22, 95% CI 0.09-0.49; P < .001) were the main independent predictors of HCPR after clopidogrel loading dose, whereas only T2DM (OR 2.98, 95% CI 1.20-7.41, P = .017) was an important independent predictor of HCPR at 4 months. CONCLUSIONS: Both MS and T2DM were independent predictors of HCPR after clopidogrel loading dose. On clopidogrel maintenance therapy, only T2DM remained an independent predictor. This observation may be clinically relevant in the current era of antiplatelet therapy.
BACKGROUND: Previous studies, which compared the prevalence of high on-clopidogrel platelet reactivity (HCPR) in type 2 diabetes mellitus (T2DM) versus non-T2DM and obese versus nonobesepatients provided conflicting results. METHODS: We compared the prevalence of HCPR in patients with T2DM, metabolic syndrome (MS), or neither T2DM nor MS undergoing drug-eluting stent implantation for stable coronary artery disease. Platelet functions were measured after a 600-mg clopidogrel loading dose and after 4 months on clopidogrel 75 mg/d. RESULTS: The prevalence of HCPR was significantly higher in 63 T2DM and 50 MSpatients than in 43 patients with neither T2DM nor MS (46.0% and 52.0% vs 20.9%) after clopidogrel loading dose, whereas, at 4 months, only T2DM patients had a significantly higher prevalence of HCPR (50.8% and 31.3% vs 23.8%). By multivariable analysis, T2DM (odds ratio [OR] 3.62, 95% CI, 1.34-9.80, P = .011), MS (OR 4.00, 95% CI 1.39-11.46, P = .010), and previous chronic treatment with clopidogrel (OR 0.22, 95% CI 0.09-0.49; P < .001) were the main independent predictors of HCPR after clopidogrel loading dose, whereas only T2DM (OR 2.98, 95% CI 1.20-7.41, P = .017) was an important independent predictor of HCPR at 4 months. CONCLUSIONS: Both MS and T2DM were independent predictors of HCPR after clopidogrel loading dose. On clopidogrel maintenance therapy, only T2DM remained an independent predictor. This observation may be clinically relevant in the current era of antiplatelet therapy.
Authors: Emelia J Benjamin; Michael J Blaha; Stephanie E Chiuve; Mary Cushman; Sandeep R Das; Rajat Deo; Sarah D de Ferranti; James Floyd; Myriam Fornage; Cathleen Gillespie; Carmen R Isasi; Monik C Jiménez; Lori Chaffin Jordan; Suzanne E Judd; Daniel Lackland; Judith H Lichtman; Lynda Lisabeth; Simin Liu; Chris T Longenecker; Rachel H Mackey; Kunihiro Matsushita; Dariush Mozaffarian; Michael E Mussolino; Khurram Nasir; Robert W Neumar; Latha Palaniappan; Dilip K Pandey; Ravi R Thiagarajan; Mathew J Reeves; Matthew Ritchey; Carlos J Rodriguez; Gregory A Roth; Wayne D Rosamond; Comilla Sasson; Amytis Towfighi; Connie W Tsao; Melanie B Turner; Salim S Virani; Jenifer H Voeks; Joshua Z Willey; John T Wilkins; Jason Hy Wu; Heather M Alger; Sally S Wong; Paul Muntner Journal: Circulation Date: 2017-01-25 Impact factor: 29.690
Authors: Deepak L Bhatt; Kim Fox; Robert A Harrington; Lawrence A Leiter; Shamir R Mehta; Tabassome Simon; Marielle Andersson; Anders Himmelmann; Wilhelm Ridderstråle; Claes Held; Philippe Gabriel Steg Journal: Clin Cardiol Date: 2019-04-09 Impact factor: 2.882
Authors: Krzysztof Kukula; Mariusz Klopotowski; Joanna Was; Aleksandra Wrobel; Jacek Jamiolkowski; Artur Debski; Pawel Bekta; Zbigniew Chmielak; Adam Witkowski Journal: Postepy Kardiol Interwencyjnej Date: 2017-09-25 Impact factor: 1.426