Abstract 16762: Lower Bleeding Risk Following PCI in Patients With Diabetes Prescribed Prolonged Dual Anti Platelet Therapy
Background: Patients with diabetes (DM) experience higher rates of in-stent restenosis and therefore greater benefit from DES implant at the time of PCI, necessitating prolonged dual anti-platelet therapy (DAPT). While DAPT reduces the risk of ischemic events post-PCI, it also increases the risk for bleeding. Whether long term rates of bleeding differ among patients with and without DM receiving DAPT in real-world practice is unknown.
Methods: Among patients who underwent PCI and were maintained on DAPT for 1 year in a multicenter US PCI registry, we assessed patient-reported bleeding (defined according to the Bleeding Academic Research Consortium) over the year following PCI in patients with and without DM. Multivariable, hierarchical modified Poisson regression was used to evaluate the association of DM with bleeding during follow-up. In a sensitivity analysis, we excluded bruising from BARC-defined bleeding events.
Results: Among 2334 PCI patients from 10 US hospitals (mean age 64, 67% male, 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<0.001; BARC ≥ 2: 4.3% vs 5.3%, p=0.33). After adjusting for demographic and clinical factors, patients with DM had a lower risk of BARC ≥1 bleeding during follow-up (relative risk [RR] 0.89, 95% CI 0.83-0.96 vs. no DM). This decreased risk of bleeding did not vary by PCI indication (ACS vs. elective; p-interaction=0.47) and persisted after removing bruising from the endpoint definition (RR 0.92, 95% CI 0.85-0.99).
Conclusions: In a real-world PCI registry, patients with DM experienced significantly lower risk of bleeding on DAPT than those without DM. As patients with DM also derive greater ischemic benefit from DES, which requires prolonged DAPT, our findings suggest that the balance between benefit and risk of this therapeutic approach is even more favorable in patients with DM than previously considered.
Author Disclosures: A. Grodzinsky: Research Grant; Significant; T32 training grant (HL110837). S.V. Arnold: None. T.Y. Wang: Research Grant; Significant; Lilly USA, Daiichi Sankyo, Gilead Science, GlaxoSmith Kline, American College of Cardiology, American Society of Nuclear Cardiology. Honoraria; Significant; Astra Zeneca, American College of Cardiology Foundation. P.K. Sharma: Ownership Interest; Significant; Co-Founder InnovaHeart LLC. K. Gosch: None. P.G. Jones: None. D.L. Bhatt: Research Grant; Significant; Amarin, Astra Zeneca, Bristol-Myers Squibb, Eisai, Ethicon, Medtronic, Roche, Sanofi Aventis, The Medicines Company. P.G. Steg: Research Grant; Significant; sanofi, servier. Honoraria; Significant; Astra Zeneca, Amarin, Bayer, Bristol Myers Squibb, Daiichi Sankyo, GlaxoSmithKline, Lilly, Merck, Pfizer, Sanofi, Servier, The Medicines Company, Vivus. Ownership Interest; Significant; Aterovax. Consultant/Advisory Board; Significant; Novartis, Otsuka. D.J. Cohen: Speakers Bureau; Modest; Astra Zeneca, Eli Lily. Consultant/Advisory Board; Modest; Astra Zeneca, Eli Lilly, Medtronic, Abbott Vascular. Research Grant; Significant; Medtronic, Edwards Lifesciences, Abbott Vascular, Boston Scientific, Eli Lilly, Daiichi Sankyo, Astra Zeneca, Merck, Biomet, Cardiovascular Systems, Inc. J.A. Spertus: Research Grant; Significant; NIH, AHA, Eli Lilly, Amorcyte, Genentech. A.K. Chhatriwalla: None. M. Kosiborod: Research Grant; Significant; AHA, Genentech, Sanofi Aventis, Gilead Sciences, Medtronic Minimed. Consultant/Advisory Board; Modest; Genentech, Gilead, Hoffman LaRoche, AstraZeneca, Medtronic.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.