title: Bleeding risk following percutaneous coronary intervention in patients with diabetes prescribed dual anti-platelet therapy.
abstract: BACKGROUND
  Patients with diabetes mellitus (DM) experience higher rates of in-stent restenosis and greater benefit from drug-eluting stents implant at the time of percutaneous coronary intervention (PCI), necessitating prolonged dual anti-platelet therapy (DAPT). While DAPT reduces risk of ischemic events post-PCI, it also increases risk of bleeding. Whether bleeding rates differ among patients with and without DM, receiving long-term DAPT is unknown.
  
  
  METHODS
  Among patients who underwent PCI and were maintained on DAPT for 1 year in a multicenter US registry, we assessed patient-reported bleeding over one year following PCI in patients with and without DM. Multivariable, hierarchical Poisson regression was used to evaluate the association of DM with bleeding during follow-up.
  
  
  RESULTS
  Among 2334 PCI patients from 10 US hospitals (mean age 64, 54% ACS), 32.6% had DM. In unadjusted analyses, patients with DM had fewer bleeding events over the year following PCI (DM vs no DM: BARC = 1: 78.0% vs 87.7%, P < .001; BARC ≥2: 4.3% vs 5.3%, P = .33). Following adjustment, patients with (vs without DM) had a lower risk of BARC ≥1 bleeding during follow-up (relative risk [RR] 0.89, 95% CI 0.83-0.96). This decreased bleeding risk persisted after removing bruising from the endpoint definition.
  
  
  CONCLUSIONS
  In a real-world PCI registry, patients with DM experienced lower risk of bleeding risk on DAPT. As patients with DM also derive greater ischemic benefit from drug-eluting stents, which requires prolonged DAPT, our findings suggest that the balance between benefit and risk of this therapeutic approach may be even more favorable in patients with DM than previously considered.
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO. Electronic address: agrodzinsky@gmail.com.
authors.forename: Anna
authors.initials: A
authors.lastname: Grodzinsky
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Suzanne V
authors.initials: SV
authors.lastname: Arnold
authors.affiliation: Duke Clinical Research Institute, 2400 Pratt Street, Durham, NC.
authors.forename: Tracy Y
authors.initials: TY
authors.lastname: Wang
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Praneet
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO.
authors.forename: Kensey
authors.initials: K
authors.lastname: Gosch
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO.
authors.forename: Philip G
authors.initials: PG
authors.lastname: Jones
authors.affiliation: Brigham and Women's Hospital Heart & Vascular Center and Harvard Medical School, 75 Francis Street, Boston, MA.
authors.forename: Deepak L
authors.initials: DL
authors.lastname: Bhatt
authors.affiliation: University Paris Diderot, INSERM U1148, AP-HP, Paris, France.
authors.forename: Philippe Gabriel
authors.initials: PG
authors.lastname: Steg
authors.affiliation: Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, TX.
authors.forename: Darren K
authors.initials: DK
authors.lastname: McGuire
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: David J
authors.initials: DJ
authors.lastname: Cohen
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: John A
authors.initials: JA
authors.lastname: Spertus
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Adnan K
authors.initials: AK
authors.lastname: Chhatriwalla
authors.affiliation: Department of Molecular and Clinical Medicine, University of Gothenburg, Gothenburg, Sweden and Department of Medicine, NU-Hospital Organization, Uddevalla, Sweden.
authors.forename: Marcus
authors.initials: M
authors.lastname: Lind
authors.affiliation: Aetna Foundation, University of Connecticut, Hartford, CT.
authors.forename: Garth
authors.initials: G
authors.lastname: Graham
authors.affiliation: Saint Luke's Mid America Heart Institute, 4401 Wornall Rd, Kansas City, MO; University of Missouri-Kansas City, Kansas City, MO.
authors.forename: Mikhail
authors.initials: M
authors.lastname: Kosiborod
mesh_terms: D000368:Aged; D001241:Aspirin / Q000008:administration & dosage / Q000009:adverse effects; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004359:Drug Therapy, Combination / Q000009:adverse effects / Q000379:methods / Q000706:statistics & numerical data; D054855:Drug-Eluting Stents; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced / Q000453:epidemiology; D006801:Humans; D000069451:Long Term Adverse Effects / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage / Q000009:adverse effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects; D012042:Registries / Q000706:statistics & numerical data; D018570:Risk Assessment
chemical_list: D010975:Platelet Aggregation Inhibitors; D011725:Pyridines; C446540:thienopyridine; D001241:Aspirin