Author + information
- Frans J.J. Van de Werf,
- Yaling Han,
- Xavier Rossello,
- Yong Huo,
- Stuart J. Pocock,
- Yi Li,
- Jie Jiang,
- Ana Maria Vega,
- Jesús Medina and
- Héctor Bueno
Background: The impact of a change in antiplatelet management (APM) after an acute coronary syndrome (ACS) in diabetic patients is unknown. We studied the effect of a switch from dual antiplatelet therapy (DAPT) to single APT (SAPT) on events in patients discharged alive by diabetes status in the EPICOR and EPICOR Asia studies.
Methods: EPICOR (long-tErm follow-uP of anti-thrombotic management patterns In acute CORonary syndrome patients, NCT01171404) and EPICOR Asia (NCT01361386) are prospective, observational studies in 23,489 surviving ACS patients with 2-y follow up from 28 countries in Asia, Europe and Latin America. Study group was patients discharged on DAPT. Associations between changes in APM and events (cardiovascular [CV; composite of death, MI and stroke] and bleeding) by diabetes status were analyzed by Cox proportional hazards (adjusted).
Results: Overall, 17,382 patients were discharged on DAPT (23% diabetic); during follow up, 60% of diabetics and 55% of non-diabetics remained on DAPT for 2-y, the remaining patients being switched to SAPT or even no APT. CV event rate at 2-y was higher in diabetics (10.3% vs 5.3%, p<0.001) with a trend for increased bleeding risk (2.3% vs 1.9%, p=0.074). Diabetics who switched to SAPT had an increased risk for CV events (HR 1.68, 95% CI 1.28-2.21), with increased bleeding risk versus non-diabetics (Table).
Conclusions: Most ACS patients remain on DAPT after 1-y. After a switch from DAPT to SAPT risk of events increased more in diabetics than in non-diabetics.
Poster Hall, Hall C
Friday, March 17, 2017, 3:45 p.m.-4:30 p.m.
Session Title: Coronary Angiography, Intra-Vascular Imaging, Revascularization and Outcomes
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1166-318
- 2017 American College of Cardiology Foundation