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


CONCLUSIONS
HRPR is a strong marker of increased risk of cardiac death in patients with DM who underwent PCI for CTO.
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Renato
R
Valenti
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Giulia
G
Cantini
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Post-graduate School in Cardiology, University of Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy.
Rossella
R
Marcucci
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Marco
M
Marrani
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Angela
A
Migliorini
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Nazario
N
Carrabba
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Vincenzo
V
Comito
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Ruben
R
Vergara
Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
Giampaolo
G
Cerisano
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Post-graduate School in Cardiology, University of Florence, Italy.
Guido
G
Parodi
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Post-graduate School in Cardiology, University of Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy.
Rosanna
R
Abbate
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy; Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence, Italy.
Anna Maria
AM
Gori
Department of Heart and Vessels, Careggi Hospital, Florence, Italy; Post-graduate School in Cardiology, University of Florence, Italy; Department of Clinical and Experimental Medicine, University of Florence, Italy; Don Carlo Gnocchi Foundation, Centro S. Maria agli Ulivi, Onlus IRCCS, Florence, Italy.
Gian Franco
GF
Gensini
Department of Heart and Vessels, Careggi Hospital, Florence, Italy. Electronic address: david.antoniucci@virgilio.it.
David
D
Antoniucci
D000368:Aged; D001792:Blood Platelets / Q000502:physiology*; D002908:Chronic Disease; D000077144:Clopidogrel; D054059:Coronary Occlusion / Q000097:blood / Q000401:mortality / Q000601:surgery*; D003920:Diabetes Mellitus / Q000097:blood* / Q000401:mortality; D004305:Dose-Response Relationship, Drug; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000453:epidemiology / Q000517:prevention & control; D006801:Humans; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects*; D015539:Platelet Activation / Q000502:physiology*; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D010979:Platelet Function Tests; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D013988:Ticlopidine / Q000008:administration & dosage / Q000031:analogs & derivatives; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
Coronary occlusion; Diabetes mellitus; Platelet reactivity