Impact of Diabetes Mellitus and chronic kidney disease on cardiovascular outcomes and platelet P2Y12 receptor antagonist effects in patients with acute coronary syndromes

• Verfasst von: Franchi, Francesco [VerfasserIn]
• Verfasst von: Katus, Hugo [VerfasserIn]
• Titel: Impact of Diabetes Mellitus and chronic kidney disease on cardiovascular outcomes and platelet P2Y12 receptor antagonist effects in patients with acute coronary syndromes
• Titelzusatz: insights from the PLATO Trial
• Verf.angabe: Francesco Franchi, MD; Stefan K. James, MD, PhD; Tatevik Ghukasyan Lakic, MSc; Andrzej J. Budaj, MD, PhD; Jan H. Cornel, MD, PhD; Hugo A. Katus, MD; Matyas Keltai, MD, DSc; Frederic Kontny, MD, PhD; Basil S. Lewis, MD; Robert F. Storey, MD, DM; Anders Himmelmann, MD, PhD; Lars Wallentin, MD, PhD; Dominick J. Angiolillo, MD, PhD; on behalf of the PLATO Investigators
• E-Jahr: 2019
• Jahr: 12 Mar 2019
• Umfang: 21 S.
• Fussnoten: Gesehen am 12.03.2020
• Titel Quelle: Enthalten in: American Heart AssociationJournal of the American Heart Association
• Ort Quelle: New York, NY : Association, 2012
• Jahr Quelle: 2019
• Band/Heft Quelle: 8(2019,6) Artikel-Nummer e011139, 21 Seiten
• ISSN Quelle: 2047-9980
• DOI: doi:10.1161/JAHA.118.011139
• Datenträger: Online-Ressource
• Sprache: eng
• K10plus-PPN: 1692398601

Abstract

BackgroundThere are limited data on how the combination of diabetes mellitus (DM) and chronic kidney disease (CKD) affects cardiovascular outcomes as well as response to different P2Y12 receptor antagonists, which represented the aim of the present investigation.Methods and ResultsIn this post hoc analysis of the PLATO (Platelet Inhibition and Patient Outcomes) trial, which randomized acute coronary syndrome patients to ticagrelor versus clopidogrel, patients (n=15 108) with available DM and CKD status were classified into 4 groups: DM+/CKD+ (n=1058), DM+/CKD− (n=2748), DM−/CKD+ (n=2160), and DM−/CKD− (n=9142). The primary efficacy end point was a composite of cardiovascular death, myocardial infarction, or stroke at 12 months. The primary safety end point was PLATO major bleeding. DM+/CKD+ patients had a higher incidence of the primary end point compared with DM−/CKD− patients (23.3% versus 7.1%; adjusted hazard ratio 2.22; 95% CI 1.88-2.63; P<0.001). Patients with DM+/CKD− and DM−/CKD+ had an intermediate risk profile. The same trend was shown for the individual components of the primary end point and for major bleeding. Compared with clopidogrel, ticagrelor reduced the incidence of the primary end point consistently across subgroups (P‐interaction=0.264), but with an increased absolute risk reduction in DM+/CKD+. The effects on major bleeding were also consistent across subgroups (P‐interaction=0.288).ConclusionsIn acute coronary syndrome patients, a gradient of risk was observed according to the presence or absence of DM and CKD, with patients having both risk factors at the highest risk. Although the ischemic benefit of ticagrelor over clopidogrel was consistent in all subgroups, the absolute risk reduction was greatest in patients with both DM and CKD.Clinical Trial RegistrationURL: http://www.clinicatrials.gov. Unique identifier: NCT00391872.