Hamilos Michalis, Petousis Stylianos, Xanthopoulou Ioanna, Goudevenos John, Kanakakis John, Sitafidis George, Vavouranakis Manolis, Skalidis Emmanuel, Kochiadakis George, Lekakis John, Vardas Panos E, Alexopoulos Dimitrios
Department of Cardiology, Heraklion University Hospital, Heraklion.
Department of Cardiology, Patras University Hospital, Patras.
Coron Artery Dis. 2018 Jan;29(1):53-59. doi: 10.1097/MCA.0000000000000547.
We compared the clinical outcome of diabetic versus nondiabetic patients with acute coronary syndrome (ACS) undergoing percutaneous coronary intervention (PCI) in the GReek AntiPlatElet (GRAPE) registry.
GRAPE is a prospective observational study, focusing on contemporary antiplatelet use in moderate-risk to high-risk ACS patients receiving PCI. Major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and bleeding events (Bleeding Academic Research Consortium definition) at 1 year of follow-up were analyzed using propensity score adjustment. A subanalysis according to diabetes mellitus (DM) status was performed.
Out of 2047 registered patients, 469 (22.9%) were diabetic. Complete 1-year follow-up was available in 95.1% of patients. MACE occurred in 12.2 and 7.2% of those patients with and without DM, respectively [adjusted hazard ratio (HR), 95% confidence interval (CI)=1.27 (0.89-1.79), P=0.2]. Observed BARC type ≥3 bleeding risk was not higher in diabetic patients: adjusted HR (95% CI)=1.20 (0.79-1.84). In the subgroup of clopidogrel-treated patients (N=238), MACE rate was significantly higher in diabetic compared with nondiabetic cohort [13.4 vs. 9%, adjusted HR (95% CI)=1.68 (1.07-2.64), P=0.03]. In the subgroup of ticagrelor-treated or prasugrel-treated patients (N=228), MACE rate did not differ significantly between diabetic and nondiabetic patients: 9.6 versus 5%, adjusted HR (95% CI)=1.35 (0.77-2.37), P=0.38.
In 'real-life' ACS undergoing PCI, diabetic patients have higher - although not significantly - MACE rate and no difference in bleeding events. This difference in MACE was significant among clopidogrel-treated patients, whereas when newer antiplatelet agents were used the negative impact of DM on ischemic events was eliminated.
我们在希腊抗血小板（GRAPE）注册研究中比较了接受经皮冠状动脉介入治疗（PCI）的急性冠状动脉综合征（ACS）糖尿病患者与非糖尿病患者的临床结局。
GRAPE是一项前瞻性观察性研究，重点关注接受PCI的中高危ACS患者的当代抗血小板药物使用情况。使用倾向评分调整分析了随访1年时的主要不良心血管事件（MACE，包括死亡、非致命性心肌梗死、紧急血运重建和中风的复合事件）和出血事件（按照出血学术研究联盟的定义）。根据糖尿病（DM）状态进行了亚组分析。
在2047例注册患者中，469例（22.9%）为糖尿病患者。95.1%的患者有完整的1年随访数据。DM患者和非DM患者中MACE的发生率分别为12.2%和7.2%[调整后风险比（HR），95%置信区间（CI）=1.27（0.89 - 1.79），P = 0.2]。观察到糖尿病患者中BARC 3型及以上出血风险并不更高：调整后HR（95% CI）=1.20（0.79 - 1.84）。在接受氯吡格雷治疗的患者亚组（N = 238）中，糖尿病患者的MACE发生率显著高于非糖尿病队列[分别为13.4%和9%，调整后HR（95% CI）=1.68（1.07 - 2.64），P = 0.03]。在接受替格瑞洛或普拉格雷治疗的患者亚组（N = 228）中，糖尿病患者和非糖尿病患者的MACE发生率无显著差异：分别为9.6%和5%，调整后HR（95% CI）=1.35（0.77 - 2.37），P = 0.38。
在接受PCI的“现实生活”中的ACS患者中，糖尿病患者的MACE发生率较高——尽管无显著差异——且出血事件无差异。在接受氯吡格雷治疗的患者中，MACE的这种差异显著，而当使用新型抗血小板药物时，DM对缺血事件的负面影响被消除。
