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  • Franchi, FrancescoUniv Florida, Coll Med, 655 W 8th St, Jacksonville, FL 32209 USA (author)

Impact of Diabetes Mellitus and Chronic Kidney Disease on Cardiovascular Outcomes and Platelet P2Y12 Receptor Antagonist Effects in Patients With Acute Coronary Syndromes : Insights From the PLATO Trial

  • Article/chapterEnglish2019

Publisher, publication year, extent ...

  • 2019
  • electronicrdacarrier

Numbers

  • LIBRIS-ID:oai:DiVA.org:uu-394176
  • https://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-394176URI
  • https://doi.org/10.1161/JAHA.118.011139DOI

Supplementary language notes

  • Language:English
  • Summary in:English

Part of subdatabase

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  • Subject category:ref swepub-contenttype
  • Subject category:art swepub-publicationtype

Notes

  • Background-There 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 P2Y(12) receptor antagonists, which represented the aim of the present investigation. Methods and Results-In 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). Conclusions-In 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.

Subject headings and genre

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  • James, Stefan,1964-Uppsala universitet,Kardiologi(Swepub:uu)stjam367 (author)
  • Ghukasyan, TatevikUppsala universitet,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)tatgh570 (author)
  • Budaj, Andrzej J.Grochowski Hosp, Postgrad Med Sch, Warsaw, Poland (author)
  • Cornel, Jan H.Noordwest Ziekenhuisgrp, Dept Cardiol, Alkmaar, Netherlands (author)
  • Katus, Hugo A.Univ Klinikum Heidelberg, Med Klin, Heidelberg, Germany (author)
  • Keltai, MatyasSemmelweis Univ, Hungarian Inst Cardiol, Budapest, Hungary;Semmelweis Univ, Budapest, Hungary (author)
  • Kontny, FredericStavanger Univ Hosp, Dept Cardiol, Stavanger, Norway;Volvat Med Ctr, Oslo, Norway (author)
  • Lewis, Basil S.Lady Davis Carmel Med Ctr, Haifa, Israel;Lady Davis Carmel Med Ctr, Haifa, Israel (author)
  • Storey, Robert F.Univ Sheffield, Dept Infect Immun & Cardiovasc Dis, Sheffield, S Yorkshire, England;Northern Gen Hosp, Ctr Clin Sci, Sheffield, S Yorkshire, England;Univ Sheffield, Sheffield, S Yorkshire, England (author)
  • Himmelmann, AndersAstraZeneca, Res & Dev, Gothenburg, Sweden (author)
  • Wallentin, Lars,1943-Uppsala universitet,Kardiologi,Uppsala kliniska forskningscentrum (UCR)(Swepub:uu)larswall (author)
  • Angiolillo, Dominick J.Univ Florida, Coll Med, 655 W 8th St, Jacksonville, FL 32209 USA (author)
  • Parkhomenko, Alexander NikolaevichRes Inst Cardiol, Kiev, Ukraine (author)
  • Oto, AliHacettepe Univ, Sch Med, Ankara, Turkey (author)
  • Skene, AllanWorldwide Clin Trials Inc, Nottingham, England (author)
  • Budaj, AndrzejGrochowski Hosp, Warsaw, Poland (author)
  • Freij, AnneliAstraZeneca, Molndal, Sweden (author)
  • Santoso, AnwarUdayana Sch Med, Denpasar, Indonesia (author)
  • Armando, AHosp Cardiol UMAE, Garcia Castillo, Nuevo Leon, Mexico (author)
  • Meier, BernhardUniv Hosp, Bern, Switzerland (author)
  • Yu, Cheuk ManChinese Univ Hong Kong, Hong Kong, Peoples R China (author)
  • Cannon, Christopher P.Brigham & Womens Hosp, TIMI Study Grp, 75 Francis St, Boston, MA 02115 USA (author)
  • Zambahari, Dato Seri RobaayahNatl Heart Inst, Kuala Lumpur, Malaysia (author)
  • Wu, Delon WuChang Gung Mem Hosp Linkou, Taoyuan, Taiwan (author)
  • Ardissino, DiegoOsped Maggiore Parma, Parma, Italy (author)
  • Raev, Dimitar (author)
  • Kremastinos, DimitriosMinist Interior, Inst Med, Sofia, Bulgaria;Attikon Univ Gen Hosp, Athens, Greece (author)
  • Weaver, DouglasHenry Ford Heart & Vasc Inst, Detroit, MI USA (author)
  • Paolasso, ErnestoEstudios Clin Latin Amer, Rosario, Santa Fe, Argentina (author)
  • Giannitsis, EvangelosHeidelberg Univ, Heidelberg, Germany (author)
  • Verheugt, FreekRadboud Univ Nijmegen Med Ctr, Nijmegen, Netherlands (author)
  • Maurer, Gerald (author)
  • Katus, Hugo (author)
  • Emanuelsson, Hakan (author)
  • Horrow, JayAstraZeneca, Wilmington, DE USA (author)
  • Bassand, Jean-PierreUniv Hosp Jean Minjoz, Besancon, France (author)
  • Spinar, JindrichUniv Hosp Brno, Brno, Czech Republic (author)
  • Morais, JoaoSanto Andres Hosp, Leiria, Portugal (author)
  • Lopez Sendon, JoseHosp Univ La Paz, Madrid, Spain (author)
  • Nicolau, JoseHeart Inst InCor, Sao Paulo, Brazil (author)
  • Seung, Ki-BaeKangnam St Marys Hosp, Seoul, South Korea (author)
  • Teik, Lim SooHeart Ctr, Singapore, Singapore (author)
  • Heras, MagdaHosp Clin Barcelona, Barcelona, Spain (author)
  • Claeys, Marc J.Univ Antwerp Hosp, Edegem, Belgium (author)
  • Sabatine, MarcBrigham & Womens Hosp, 75 Francis St, Boston, MA 02115 USA (author)
  • Vintila, MariusSt Pantelimon Univ Hosp, Bucharest, Romania (author)
  • Ruda, MikhailCardiol Res Ctr, Moscow, Russia (author)
  • Thorsen, MonaAstraZeneca, Molndal, Sweden (author)
  • Kleiman, NeilBaylor Coll Med, Houston, TX 77030 USA (author)
  • Babilonia, NoePhilippine Heart Ctr, Quezon City, Philippines (author)
  • Commerford, PatrickGroote Schuur Hosp, Cape Town, South Africa (author)
  • Gurbel, PaulSinai Hosp, 2401 W Belvedere Ave, Baltimore, MD 21215 USA (author)
  • Aylward, PhilFlinders Med Ctr, Bedford Pk, SA, Australia (author)
  • Steg, Philippe GabrielHosp Bichat Claude Bernard, Paris, France (author)
  • Theroux, PierreMontreal Heart Inst, Montreal, PQ, Canada (author)
  • Sritara, PiyamitrRamathibodi Hosp, Bangkok, Thailand (author)
  • Pais, PremSt Johns Med Coll, Bangalore, Karnataka, India (author)
  • Becker, RichardDuke Clin Res Inst, Durham, NC USA (author)
  • Lassila, RiittaHelsinki Univ Cent Hosp, Helsinki, Finland (author)
  • Harrington, Robert A.Duke Clin Res Inst, Durham, NC USA (author)
  • Gao, RunlinCardiovasc Inst, Beijing, Peoples R China;Fu Wai Hosp, Beijing, Peoples R China (author)
  • Husted, SteenAarhus Univ Hosp, Aarhus, Denmark (author)
  • Duris, TiborHosp Nove Zamky, Nove Zamky, Slovakia (author)
  • Chapichadze, ZazaInst Cardiol, Tblisi, Georgia (author)
  • Univ Florida, Coll Med, 655 W 8th St, Jacksonville, FL 32209 USAKardiologi (creator_code:org_t)

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  • In:Journal of the American Heart Association8:62047-9980

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