title: Impact of diabetes mellitus and metabolic syndrome on acute and chronic on-clopidogrel platelet reactivity in patients with stable coronary artery disease undergoing drug-eluting stent placement.
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.
authors.affiliation: 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.
authors.forename: Laurent
authors.initials: L
authors.lastname: Feldman
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Tubach
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France.
authors.forename: Jean-Michel
authors.initials: JM
authors.lastname: Juliard
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France.
authors.forename: Dominique
authors.initials: D
authors.lastname: Himbert
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France.
authors.forename: Grégory
authors.initials: G
authors.lastname: Ducrocq
authors.affiliation: Service de Médecine Nucléaire, AP-HP, Hôpital Bichat, Paris, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Sorbets
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France.
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Triantafyllou
authors.affiliation: Cardiology Department, Rambam Medical Center, Haifa, Israel.
authors.forename: Arthur
authors.initials: A
authors.lastname: Kerner
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France.
authors.forename: Hélène
authors.initials: H
authors.lastname: Abergel
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France; Service d'Hémostase, AP-HP, Hôpital Bichat, Paris France.
authors.forename: Marie-Geneviève
authors.initials: MG
authors.lastname: Huisse
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; Service de Diabétologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris France; U872, INSERM, Paris, France.
authors.forename: Ronan
authors.initials: R
authors.lastname: Roussel
authors.affiliation: Département d'Epidémiologie et Recherche Clinique, AP-HP, Hôpital Bichat, Paris, France; INSERM CIE, Paris, France.
authors.forename: Marina
authors.initials: M
authors.lastname: Esposito-Farèse
authors.affiliation: Département de Cardiologie, AP-HP, DHU-FIRE, Hôpital Bichat, Paris, France; Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Université Paris-Diderot, Sorbonne Paris-Cité, Paris, France; U-1148, INSERM, Paris, France; Service d'Hémostase, AP-HP, Hôpital Bichat, Paris France.
authors.forename: Nadine
authors.initials: N
authors.lastname: Ajzenberg
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000379:methods*; D000077144:Clopidogrel; D003324:Coronary Artery Disease / Q000150:complications / Q000378:metabolism / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000378:metabolism; D004305:Dose-Response Relationship, Drug; D016903:Drug Monitoring; D054855:Drug-Eluting Stents; D005260:Female; D005602:France; D006801:Humans; D007557:Israel; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications / Q000378:metabolism; D008875:Middle Aged; D016017:Odds Ratio; D015539:Platelet Activation / Q000187:drug effects*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects / Q000493:pharmacokinetics; D010979:Platelet Function Tests / Q000379:methods; D011379:Prognosis; D011446:Prospective Studies; D013988:Ticlopidine / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000493:pharmacokinetics
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine