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Anti-thrombotic and glucose lowering therapy in diabetic patients undergoing PCI: Baseline inclusion data of the ARTHEMIS multicentre registry
Session:
Comunicações Orais - Sessão 06 - Intervenção coronária
Speaker:
Sérgio Baptista
Congress:
CPC 2023
Topic:
H. Interventional Cardiology and Cardiovascular Surgery
Theme:
25. Interventional Cardiology
Subtheme:
25.2 Coronary Intervention
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sérgio Bravo Baptista; Gustavo Pires-Morais; Luis Almeida Morais; João Costa; Hugo Vinhas; Gustavo Campos; Pedro Carrilho Ferreira; Nélson Vale; Filipe Seixo; Miguel Santos; Cristina Martins; Diogo Rodrigues Brás; André Alexandre; Luis Raposo
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Background and aims. </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Diabetes (DM) is a major determinant of ischemic events after percutaneous coronary intervention (PCI). In a nationwide prospective registry, treatment regimens, compliance and 2-year clinical outcomes were studied in unselected patients with DM undergoing PCI. The current analysis describes the population’s baseline characteristics and the prescription patterns of anti-thrombotic and glucose-lowering drugs. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Population and Methods. </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Between January and November 2021, 1000 consecutive pts with type-2 diabetes undergoing PCI with stent implantation were enrolled in 12 hospitals. In addition to clinical and procedural-related characteristics, data on diabetes status, CAD complexity (SYNTAX Score), as well as thrombotic and bleeding risks (DAPT and PRECISE DAPT Scores, respectively), were registered. Planned duration of dual anti-platelet therapy was also recorded. Data was collected in a dedicated web-based e-CRF and randomly audited for quality.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Results. </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Mean age was 68±13 yo, and 70% of participants were men. Classical risk factors where highly prevalent and one third had clinically overt CAD (28% AMI and 31% prior revascularization). Mean LVEF was 49±12% and 8% of pts had a prior admission due to heart failure. Indication for PCI was an ACS in 55.4% of cases and 63% had 2-3 vessel CAD (mean SYNTAX score 15.6±10.7; mean stent length and diameter 26.3±14.8 and 3.0±1.2 mm, respectively). </span></span><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Most patients (>98%) were discharged on DAPT, but only 42% received potent P2Y12 inhibitors. </span></span><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Recommendation for short DATP regimens (<u><</u>6 months,) was 35% overall and differed according to bleeding risk (30% vs 43% in low vs high-bleeding risk defined by the PRECISE-DAPT Score [mean 21.7±13.1]; p<0.001) and need for concomitant anti-coagulation (27% vs 83%; p<0.001). CAD complexity did not influence DAPT duration as it was similar across SYNTAX Score terciles (p=0.43). Prolonged DAPT (>12 months) was recommended in <1%. Self-reported duration of DM was >6-years in 56%, mean HbA1c was 7.5±1.7% and 12% had known microangiopathic involvement at inclusion. Notably, only 28% and 3% of patients were taking SGLT2 inhibitors and GLP-1 analogues on admission.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">Conclusions. </span></span></strong><span style="font-size:10.0pt"><span style="font-family:"Avenir Book"">In this population both ischemic and bleeding risks were relatively high, and prolonged DAPT was rarely prescribed, irrespective of CAD extent. Average metabolic control was off-target and guideline-directed treatment for diabetes was underused at admission, although it improved at discharge. </span></span></span></span></p>
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