Clin Res Cardiol 98, Suppl 1, April 2009

V1612 - Post-treatment platelet reactivity under dual antiplatelet therapy is increased in type II diabetes and is associated with cardiovascular outcome in diabetics undergoing coronary intervention
T. Geisler1, C. Zürn1, P. Htun1, A. Kilias1, R. Simonenko1, B. Bigalke1, K. Stellos1, A. May1, C. Herdeg1, M. Gawaz1
1Medizinische Klinik und Poliklinik III / Kardiologie, Medizinische Universitätsklinik Tübingen, Tübingen;
Background: Diabetes is accompanied by platelet function disorders leading to an increased risk for atherothrombotic events and a worse outcome after coronary interventions. Residual platelet aggregation (RPA) is considered to influence prognosis in patients with PCI.
Methods and Results: Patients admitted for coronary intervention were routinely evaluated by platelet function analysis in a monocentre registry. For the present analysis we retrospectively evaluated a consecutive cohort of 1703 patients. Patients received a 600-mg clopidogrel loading dose followed by a standard dual antiplatelet therapy. Type 2 diabetes mellitus was defined according to present guidelines. 542 patients were type 2 diabetics (31.8%) and 1161 patients non-diabetics (68.2%). Diabetics showed a higher RPA compared to non-diabetics (median final ADP-induced platelet aggregation 38.1% vs. 28.8%; p<0.001). Diabetics with HbA1C levels ≥6.5 had a significantly higher RPA than diabetics with HbA1C <6.5 (p=0.002). Platelet response after clopidogrel LD was attenuated up to 36hours in diabetics compared to non-diabetics. After adjustment for other relevant factors diabetes remained a strong predictor for increased RPA (OR 4.39; 95%CI 1.95-6.83; p<0.001). Furthermore, diabetics with increased RPA were at higher risk for 30 days major adverse events (MI, CV-death) than diabetics with a low RPA (adjusted HR 1.04, 95%CI 1.01-1.06, p=0.004).
Discussion: With the present study we demonstrate in a large scale cohort that type 2 diabetics exhibit increased RPA despite dual antiplatelet therapy. Diabetics with increased RPA had a significantly higher risk for shortterm major adverse events. Thus, alternative antiplatelet strategies have to be considered to improve cardiovascular outcome in diabetics.