Abstract 12787: Impact of Different P2Y12 Inhibitors on Cardiovascular Outcomes in Diabetic versus Non-Diabetic Patients: Insights From Real-World Data

• Published in: Circulation (New York, N.Y.) N.Y.), 2018-11, Vol.138 (Suppl_1 Suppl 1), p.A12787-A12787
• Main Authors: Shahin, Mohamed H, Kovar, Lukas G, Smith, D Max, Elsey, Amanda R, Weitzel, Kristin W, Anderson, R David, Cooper-DeHoff, Rhonda M, Nelson, David R, Johnson, Julie A, Cavallari, Larisa H
• Format: Article
• Language: English
• ISSN: 0009-7322; 1524-4539

IntroductionImpaired response to antiplatelet therapy in diabetic patients has been reported; however, limited studies have tested the effect of different P2Y12 inhibitors on cardiovascular outcomes in diabetics. Herein, we aimed to investigate the impact of diabetes on cardiovascular outcomes during treatment with different P2Y12 inhibitors after percutaneous coronary intervention (PCI).MethodsThis study included data for 618 patients prescribed P2Y12 inhibitor therapy, which was collected in a real-world setting with CYP2C19 genotyping as part of clinical care after PCI. The primary outcome of this study was a major adverse cardiovascular event (MACE) defined as the composite of first occurrence of myocardial infarction, ischemic stroke, or death within 12 months following the PCI. Log-rank test and Cox regression analyses were used to compare the risk of MACE in diabetics and non-diabetics treated with either clopidogrel or an alternative P2Y12 inhibitor (prasugrel or ticagrelor), adjusting for CYP2C19 genotype and other potential variables.ResultsAmong 618 patients, 474 (76.7%) were treated with clopidogrel, and 230 (37.2%) had diabetes. Kaplan-Meier (Figure) and Cox regression analyses revealed that clopidogrel-treated patients who had diabetes had a higher incidence of MACE compared to non-diabetics (adjusted HR2.13; 95% CI1.07 – 4.23; p = 0.03). However, no difference in MACE was observed between diabetics versus non-diabetics treated with prasugrel or ticagrelor (Cox regressionadjusted HR1.47; 95% CI0.16 – 13.13; p=0.73).ConclusionsResults from this real-world observation study reveal a higher risk for cardiovascular events in diabetics versus non-diabetics prescribed clopidogrel after PCI. However, preliminary evidence suggests no differences in risk in diabetics versus non-diabetics prescribed prasugrel or ticagrelor.