Clinical implications of diabetes mellitus in patients with acute coronary syndrome: Prognostic role and use of new P2Y 12 receptor inhibitors

• Published in: Diabetes research and clinical practice Vol. 184; p. 109215
• Main Authors: Gil-Perez, Pablo, Ruiz-Nodar, Juan Miguel, Esteve-Pastor, María Asunción, Hortelano, Ignacio, Villamía, Beatriz, Vicente-Ibarra, Nuria, Orenes-Piñero, Esteban, Macías, Manuel Jesús, Núñez-Martínez, Laura, Carrillo, Luna, Candela, Elena, Véliz-Martínez, Andrea, López-García, Cecilia, Martínez-Martínez, Juan Gabriel, Rivera-Caravaca, José Miguel, Marín, Francisco
• Format: Journal Article
• Language: English
• Published: Ireland 01.02.2022
• Subjects: Acute Coronary Syndrome - drug therapy; Diabetes Mellitus - chemically induced; Diabetes Mellitus - drug therapy; Female; Humans; Percutaneous Coronary Intervention; Platelet Aggregation Inhibitors - therapeutic use; Prognosis; Prospective Studies; Purinergic P2Y Receptor Antagonists - therapeutic use; Treatment Outcome; Prasugrel; MACE; Diabetes mellitus; Clopidogrel; Acute coronary syndrome; Ticagrelor
• ISSN: 1872-8227

We investigated the impact of diabetes mellitus (DM) in acute coronary syndrome (ACS) patients, and the 2-year prognosis based on antiplatelet therapy. This is a prospective and multicenter registry including hospitalized ACS patients. Clinical management and antiplatelet therapy at discharge were recorded. Bleeding events, all-cause mortality and major adverse cardiovascular events (MACEs) were recorded during 2-years and compared according to DM and the P2Y receptor inhibitor. From 1717 ACS patients, 653 (38%) had DM. Diabetic patients were older, more commonly females, with higher prevalence of comorbidities and more conservative management. After excluding antiplatelet monotherapy or oral anticoagulation, clopidogrel was prescribed in 59.6% of DM patients. Cox regression analysis showed that DM was an independent risk factor for MACE (aHR 1.39, 95% CI 1.05-1.83). The use of clopidogrel instead of ticagrelor/prasugrel was also independently associated with MACE (aHR 1.71, 95% CI 1.11-2.63), and all-cause mortality (aHR 2.47, 95% CI 1.23-4.96) in diabetic patients (log-rank p-values < 0.001). In ACS patients, DM was associated with higher risk of MACE. In such patients, the use of ticagrelor/prasugrel reduced MACE and mortality compared to clopidogrel. Novel P2Y receptor inhibitors might be used as the first therapeutic choice in these high-risk patients.