title: Platelet aggregation and risk of stent thrombosis or bleeding in interventionally treated diabetic patients with acute coronary syndrome.
abstract: Platelet aggregation monitoring in diabetic patients treated with coronary interventions (PCI) for an acute coronary syndrome (ACS) is a promising way of optimizing treatment and outcomes in this high risk group. The aim of the study was to verify whether clopidogrel response measured by Multiplate analyzer (ADPtest) in diabetic ACS patients treated with PCI predicts the risk of stent thrombosis or cardiovascular mortality and bleeding.
  
  
  
  Into this prospective, observational study 206 elective PCI patients were enrolled. Two cutoff points of ADPtest were used in analysis to divide patients into groups. One (345 AU x min) was calculated based on ROC curve analysis; this cutoff provided the best ROC curve fit, although it did not reach statistical significance. The other (468 AU x min) was accepted based on the consensus of the Working Group on On-Treatment Platelet Reactivity. The risk of stent thrombosis and mortality was assessed using Cox regression analysis and Kaplan-Meier curves.
  
  
  
  The risk of stent thrombosis was higher in the group of patients with impaired clopidogrel response for either cutoff value (for >354 AU x min - HR 12.33; 95% CI 2.49-61.1; P = 0.002). Cardiovascular mortality was also higher in the impaired clopidogrel response group (for >354 AU x min - HR 10.58; 95% CI 2.05-54.58; P = 0.005). We did not find a clear relation of increased clopidogrel response to the risk of bleeding.
  
  
  
  The results of this study show that in diabetic ACS patient group treated with PCI an impaired platelet response to clopidogrel measured by the Multiplate analyzer results in increased risk of stent thrombosis and cardiac death.
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland. krzysiokuk@yahoo.com.
authors.forename: K
authors.identifier: 0000-0001-5529-3507
authors.initials: K
authors.lastname: Kukula
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Klopotowski
authors.affiliation: Clinical Pharmacology Unit, Department of Clinical Biochemistry, Institute of Cardiology, Warsaw, Poland.
authors.forename: P K
authors.initials: PK
authors.lastname: Kunicki
authors.affiliation: Department of Public Health, Medical University of Bialystok, Bialystok, Poland.
authors.forename: J
authors.initials: J
authors.lastname: Jamiolkowski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Debski
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: P
authors.initials: P
authors.lastname: Bekta
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: M
authors.initials: M
authors.lastname: Polanska-Skrzypczyk
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: Z
authors.initials: Z
authors.lastname: Chmielak
authors.affiliation: Department of Interventional Cardiology and Angiology, Institute of Cardiology, Alpejska 42, 04-628, Warsaw, Poland.
authors.forename: A
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications / Q000628:therapy*; D000368:Aged; D000077144:Clopidogrel; D003920:Diabetes Mellitus / Q000097:blood / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006083:Graft Occlusion, Vascular / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006470:Hemorrhage / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D008297:Male; D010974:Platelet Aggregation; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use; D010979:Platelet Function Tests; D011044:Poland / Q000453:epidemiology; D011446:Prospective Studies; D013927:Thrombosis / Q000097:blood / Q000453:epidemiology* / Q000209:etiology; D013988:Ticlopidine / Q000009:adverse effects / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D010975:Platelet Aggregation Inhibitors; D000077144:Clopidogrel; D013988:Ticlopidine
keywords: Acute coronary syndrome; Coronary intervention; Diabetes; Platelet aggregation; Stent thrombosis