PMID- 17936152
OWN - NLM
STAT- MEDLINE
DCOM- 20071120
LR  - 20220309
IS  - 1558-3597 (Electronic)
IS  - 0735-1097 (Linking)
VI  - 50
IP  - 16
DP  - 2007 Oct 16
TI  - Impact of platelet reactivity on cardiovascular outcomes in patients with type 2 
      diabetes mellitus and coronary artery disease.
PG  - 1541-7
AB  - OBJECTIVES: This study sought to determine the prognostic implications of high 
      platelet reactivity (HPR) assessed in type 2 diabetes mellitus (T2DM) patients 
      while in their steady-state phase of dual antiplatelet therapy. BACKGROUND: Type 
      2 diabetes mellitus patients have increased platelet reactivity compared with 
      nondiabetic patients. Whether HPR assessed in T2DM while in their steady-state 
      phase of dual antiplatelet therapy is associated with an increased risk of major 
      adverse cardiovascular events (MACE) is unknown. METHODS: Platelet function 
      analyses, which included measures of platelet aggregation and activation, were 
      performed in 173 T2DM patients with coronary artery disease on chronic treatment 
      with aspirin and clopidogrel. The HPR was defined as the upper quartile of 
      maximal platelet aggregation (Agg(max)) after 20 micromol/l adenosine diphosphate 
      stimuli. Patients were followed up for 2 years and MACE were recorded. RESULTS: A 
      total of 41 MACE occurred in 34 patients (19.7%) during the 2-year follow-up. The 
      MACE occurred in 15.2%, 12.2%, 12.2%, and 37.7% of patients from the lowest to 
      upper quartile, respectively (p = 0.005). The HPR was the strongest independent 
      predictor of MACE (hazard ratio 3.35, 95% confidence interval [CI] 1.68 to 6.66, 
      p = 0.001). Receiver-operating characteristic analysis indicated that a cutoff 
      value of 62% Agg(max) best predicted MACE (37.8% vs. 13.2%, odds ratio 3.96, 95% 
      CI 1.8 to 8.7, p < 0.001). Patients with HPR had up-regulation of multiple 
      platelet signaling pathways (p < 0.0001 for all assays), indicative of a global 
      hyperreactive platelet status. CONCLUSIONS: High platelet reactivity determined 
      in T2DM patients with coronary artery disease while on chronic dual antiplatelet 
      therapy is associated with a higher risk of long-term adverse cardiovascular 
      events, suggesting the need for tailored antithrombotic drug regimens in these 
      high-risk patients.
FAU - Angiolillo, Dominick J
AU  - Angiolillo DJ
AD  - Division of Cardiology, University of Florida College of Medicine-Shands 
      Jacksonville, Jacksonville, Florida.
FAU - Bernardo, Esther
AU  - Bernardo E
FAU - Sabate, Manel
AU  - Sabate M
FAU - Jimenez-Quevedo, Pilar
AU  - Jimenez-Quevedo P
FAU - Costa, Marco A
AU  - Costa MA
FAU - Palazuelos, Jorge
AU  - Palazuelos J
FAU - Hernandez-Antolin, Rosana
AU  - Hernandez-Antolin R
FAU - Moreno, Raul
AU  - Moreno R
FAU - Escaned, Javier
AU  - Escaned J
FAU - Alfonso, Fernando
AU  - Alfonso F
FAU - Banuelos, Camino
AU  - Banuelos C
FAU - Guzman, Luis A
AU  - Guzman LA
FAU - Bass, Theodore A
AU  - Bass TA
FAU - Macaya, Carlos
AU  - Macaya C
FAU - Fernandez-Ortiz, Antonio
AU  - Fernandez-Ortiz A
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20071001
PL  - United States
TA  - J Am Coll Cardiol
JT  - Journal of the American College of Cardiology
JID - 8301365
RN  - 0 (Platelet Aggregation Inhibitors)
RN  - A74586SNO7 (Clopidogrel)
RN  - OM90ZUW7M1 (Ticlopidine)
RN  - R16CO5Y76E (Aspirin)
SB  - IM
CIN - J Am Coll Cardiol. 2007 Oct 16;50(16):1548-50. PMID: 17936153
MH  - Aged
MH  - Angina, Unstable/blood/physiopathology
MH  - Aspirin/therapeutic use
MH  - Blood Platelets/physiology
MH  - Clopidogrel
MH  - Coronary Artery Disease/*blood/drug therapy
MH  - Death, Sudden, Cardiac
MH  - Diabetes Mellitus, Type 2/*blood/drug therapy
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Multivariate Analysis
MH  - Myocardial Infarction/blood/physiopathology
MH  - Outcome Assessment, Health Care
MH  - Platelet Activation/*physiology
MH  - Platelet Aggregation/*physiology
MH  - Platelet Aggregation Inhibitors/therapeutic use
MH  - Predictive Value of Tests
MH  - Prognosis
MH  - Prospective Studies
MH  - ROC Curve
MH  - Renal Insufficiency/complications
MH  - Sensitivity and Specificity
MH  - Stroke/blood/physiopathology
MH  - Ticlopidine/analogs & derivatives/therapeutic use
EDAT- 2007/10/16 09:00
MHDA- 2007/12/06 09:00
CRDT- 2007/10/16 09:00
PHST- 2007/04/03 00:00 [received]
PHST- 2007/05/23 00:00 [revised]
PHST- 2007/05/28 00:00 [accepted]
PHST- 2007/10/16 09:00 [pubmed]
PHST- 2007/12/06 09:00 [medline]
PHST- 2007/10/16 09:00 [entrez]
AID - S0735-1097(07)02387-X [pii]
AID - 10.1016/j.jacc.2007.05.049 [doi]
PST - ppublish
SO  - J Am Coll Cardiol. 2007 Oct 16;50(16):1541-7. doi: 10.1016/j.jacc.2007.05.049. 
      Epub 2007 Oct 1.