LONG-TERM RESULTS OF CORONARY STENTING IN PATIENTS WITH IHD AND CONCOMITANT TYPE 2 DIABETES MELLITUS: VIEW THROUGH THE EFFICIENCY PRISM OF DOUBLE DISAGGREGANT THERAPY


Cite item

Full Text

Abstract

Aim. To assess the state of vascular-thrombocytic hemostasis and estimate the influence of disaggregant therapy on long-term results of coronary stenting in patients with ischemic heart disease (IHD) and concomitant type 2 diabetes mellitus (DM). Materials and methods. Retrospective analysis of influence of concomitant type 2 diabetes mellitus (DM) on the long-term results of IHD intervention treatment using the technique of coronary stenting as well as efficiency of double disaggregant therapy is presented in the paper. 165 patients were examined: group 1 - 96 patients with IHD and concomitant type 2 DM, group 2 - 69 IHD patients without carbohydrate metabolism disorders. Results. No significant differences between the groups in the average number of installed stents were revealed; type 2 DM patients more often underwent implantation of stents longer than 20 mm (χ 2=4,01, p=0,0454). According to ADP test data, no differences between the groups in the absence rate of effective clopidogrel-induced disaggregation in 48 hours after the beginning of double disaggregant therapy (19 (28,8 %) patients of the main group and 22 (27,5 %) -comparison group, p=0,05) were detected. According to the data of ASPI-test with arachidonic acid, ASA resistance statistically significantly predominated in patients of the main group - 13 (19,7 %) patients. Dynamic analysis of aggregatograms of patients from each group resulted in no statistically significant differences according to all the studied tests by the day 30 of double antiplatelet therapy in the main group, whereas in IHD patients without carbohydrate metabolism disorders growth of disaggregation conditioned by both clopidogrel and ASA was observed. Correlation analysis showed in patients with concomitant type 2 DM dependence of fatal outcome on absence of sufficient disaggregation effect of both clopidogrel and ASK. Conclusions. Combination of IHD with type 2 DM is accompanied by lesser efficiency and greater acetylsalicylic acid resistance rate in patients who underwent coronary stenting that can serve as a basis for necessity of platelet aggregation control with individualization of therapy and active use of new disaggregants in this group of patients.

About the authors

O Yu Kalugina

Email: olgasamo@yandex.ru

References

  1. Айнетдинова Д. Х., Удовиченко А. Е., Сулимов В. А. Резистентность к антитромбоцитарным препаратам у больных острым коронарным синдромом с подъемом сегмента ST. Рациональная фармакотерапия в кардиологии 2008; 2: 23-29.
  2. Бабунашвили А. М., Иванов В. А., Дундуа Д. П. Лечение коронарного атеросклероза: влияние массового применения стентов на ближайшие и отдаленные результаты коронарной ангиопластики. Архивь внутренней медицины 2011; 1, available at: http://medarhive.ru/index.php?option=com_content&view=article&id=71.
  3. Мороз Е. В. Резистентность к антитромбоцитарным препаратам (ацетилсалициловой кислоте, клопидогрелю) у больных со стабильными формами ишемической болезни сердца и облитерирующим атеросклерозом артерий нижних конечностей: автореф. дис. … канд. мед. наук. М. 2013; 26.
  4. Пя Ю. В. Ближайшие и отдаленные результаты реваскуляризации миокарда у больных ишемической болезнью сердца и сахарным диабетом. Международный эндокринологический журнал 2010; 8, available at: http://www.mif-ua.com/ archive/article/15325.
  5. Хорев Н., Мамот А., Залозный Д., Шойхет Я. Персонализация антитромбоцитарной терапии при резистентности к клопидогрелю. Проблемы клинической медицины 2012; 1: 134-139.
  6. Ariturk Z. Effect of hypoglycemic drugs on aspirin resistance in patients with diabetes mellitus. Eur. Rev. Med. Pharmacol. Sci. 2012; 16 (5): 617-621.
  7. Bonello L. Consensus and future directions on the definition of high on-treatment platelet reactivity to adenosine diphosphate. J. Am. Coll. Cardiol. 2010; 56 (12): 919-933.
  8. Deng J. Effects of chronic kidney disease on platelet response to antiplatelet therapy in acute myocardial infarction patients. Zhonghua Yi Xue Za Zhi 2012; 92 (38): 2674-2676.
  9. DiNicolantonio J. J., Tomek A. Inactivations, deletions, non-adjudications, and downgrades of clinical endpoints on ticagrelor: serious concerns over the reliability of the PLATO trial. Int. J. Cardiol. 2013; 168 (4): 4076-4080.
  10. Gori A., Marcucci R., Migliorini A. Incidence and clinical impact of dual nonresponsiveness to aspirin and clopidogrel in patients with drug-eluting stents. J. Am. Coll. Cardiol. 2008; 52 (9): 734-739.
  11. Grove E. L. Antiplatelet effect of aspirin in patients with coronary artery disease. Dan. Med. J. 2012; 59 (5): B4506.
  12. Gurbel P. Clopidogrel for coronary stenting: response variability, drug resistance, and the effect of pretreatment platelet reactivity. Circulation 2003; 107 (23): 2908-2913.
  13. Gurbel P. Response to ticagrelor in clopidogrel nonresponders and responders and the effect of switching therapies. The RESPOND study. Circulation 2010; 121: 1188-1199.
  14. Holmes D. ACCF/AHA clopidogrel clinical alert: approaches to the FDA “boxed warning”. J. Am. Coll. Cardiol. 2010; 56 (4): 321-341.
  15. Iqbal J., Sumaya W., Tatman V. Incidence and predictors of stent thrombosis: a single-centre study of 5,833 consecutive patients undergoing coronary artery stenting. EuroIntervention 2013; 9 (1): 62-69
  16. Kushner F., Hand M., Smith S. 2009 focused updates: ACC/AHA guidelines for the management of patients with ST-elevation myocardial infarction (updating the 2004 guideline and 2007 focused update) and ACC/AHA/SCAI guidelines on percutaneous coronary intervention (updating the 2005 guideline and 2007 focused update) a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J. Am. Coll. Cardiol. 2009; 54 (23): 2205-2241.
  17. Price M. Standard- vs high-dose clopidogrel based on platelet function testing after percutaneous coronary intervention. JAMA 2011; 305 (11): 1097-1105.
  18. Sharma R., Erickson S., Sharma R. Platelet function testing to predict hyporesponsiveness to clopidogrel in patients with chest pain seen in the emergency department. Vasc. Health. Risk. Manag. 2013; 9: 187-193.
  19. Steg P., Harrington R., Emanuelsson H. Stent thrombosis with ticagrelor versus clopidogrel in patients with acute coronary syndromes: an analysis from the prospective, randomized PLATO trial. Circulation 2013; 128 (10): 1055-1065.
  20. Wright R., Anderson J., Adams C. ACCF/AHA focused update of the Guidelines for the Management of Patients with Unstable Angina/Non-ST-Elevation Myocardial Infarction (updating the 2007 guideline). J. Am. Coll. Cardiol. 2011; 57 (19): 1920-1959.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Kalugina O.Y.

Creative Commons License
This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77 - 70264 от 13.07.2017 г. 
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ЭЛ № ФС 77 - 75489 от 05.04.2019 г.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies