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JACC-Cardiovasc. Interv., Mar 24 2025, 18 (6) S1936-8798(24)01818-1 | https://doi.org/10.1016/j.jcin.2024.12.002
Diabetic Status and Thrombogenicity: Association and Prognostic Implications After Percutaneous Coronary Intervention
Sungsoo Cho MD, PhD a ∗, Moonki Jung MD, PhD b,c ∗, Jong-Hwa Ahn MD, PhD d,e, Min Gyu Kang MD, PhD e,f, Jae Seok Bae MD d,e, Jin-Sin Koh MD, PhD e,f, Seok-Jae Hwang MD, PhD e,f, Hwi Seung Kim MD c,g, Sang-Wook Kim MD, PhD b,c, Jin-Yong Hwang MD, PhD e,f, Young-Hoon Jeong MD, PhD h,i
aDivision of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
bHeart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong, South Korea
cDepartment of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
dCardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
eDepartment of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
fDivision of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
gDivision of Endocrinology and Metabolism, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
hChung-Ang Universit Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
iDivision of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
aDivision of Cardiology, Department of Internal Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, South Korea
bHeart and Brain Hospital, Chung-Ang University Gwangmyeong Center, Gwangmyeong, South Korea
cDepartment of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
dCardiovascular Center, Gyeongsang National University Changwon Hospital, Changwon, South Korea
eDepartment of Internal Medicine, Gyeongsang National University School of Medicine, Jinju, South Korea
fDivision of Cardiology, Gyeongsang National University Hospital, Jinju, South Korea
gDivision of Endocrinology and Metabolism, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
hChung-Ang Universit Thrombosis and Biomarker Center, Chung-Ang University Gwangmyeong Hospital, Gwangmyeong, South Korea
iDivision of Cardiology, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, South Korea
∗These authors have contributed equally to this work.
Address for correspondence: Dr Young-Hoon Jeong, Jin-Yong Hwang MD, PhD
Address for correspondence: Dr Young-Hoon Jeong, Jin-Yong Hwang MD, PhD
Abstract
Background
A heightened prothrombotic environment, combined with premature and more aggressive atherosclerosis, contributes to the elevated cardiovascular risk in patients with diabetes mellitus (DM).
Objectives
The aim of this study was to evaluate the association between DM status and thrombogenicity and their prognostic implications in patients with significant coronary artery disease.
Methods
A total of 2,501 patients with coronary artery disease undergoing percutaneous coronary intervention, with on-admission glycated hemoglobin and thrombogenicity indexes (measured by thromboelastography). Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, myocardial infarction, or stroke within 4-year follow-up.
Results
Patients with DM (n = 970 [38.8%]) demonstrated significantly higher platelet-fibrin clot strength (PFCS), as indicated by maximal amplitude (median [Q1-Q3]: 67.1 [62.2-72.2] mm vs. 65.5 [61.0-70.4] mm; P < 0.001), and reduced fibrinolytic activity, measured by lysis at 30 minutes (median [Q1-Q3]: 0.1% [0.0%-1.0%] vs. 0.2% [0.0%-1.3%]; P = 0.003), compared to patients without DM. PFCS level was closely related with diabetic status, showing a positive relationship with glycated hemoglobin level up to 7.0% and then reaching a plateau. In a multivariable analysis, high PFCS phenotype defined as maximal amplitude ≥68 mm (HR: 1.39; 95% CI: 1.07-1.81; P = 0.015) and DM phenotype (HR: 1.38; 95% CI: 1.05-1.79; P = 0.018) were independently associated with MACE occurrence. The presence of diabetic phenotype and high PFCS exhibited an additive effect on MACE occurrence (HR: 2.49; 95% CI: 1.77-3.51; P < 0.001).
Conclusions
In percutaneous coronary intervention–treated patients, diabetic status and clot-strength value were significantly correlated. High clot-strength phenotype increased the risk for MACE, irrespective of diabetic phenotype. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529)
A heightened prothrombotic environment, combined with premature and more aggressive atherosclerosis, contributes to the elevated cardiovascular risk in patients with diabetes mellitus (DM).
Objectives
The aim of this study was to evaluate the association between DM status and thrombogenicity and their prognostic implications in patients with significant coronary artery disease.
Methods
A total of 2,501 patients with coronary artery disease undergoing percutaneous coronary intervention, with on-admission glycated hemoglobin and thrombogenicity indexes (measured by thromboelastography). Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, myocardial infarction, or stroke within 4-year follow-up.
Results
Patients with DM (n = 970 [38.8%]) demonstrated significantly higher platelet-fibrin clot strength (PFCS), as indicated by maximal amplitude (median [Q1-Q3]: 67.1 [62.2-72.2] mm vs. 65.5 [61.0-70.4] mm; P < 0.001), and reduced fibrinolytic activity, measured by lysis at 30 minutes (median [Q1-Q3]: 0.1% [0.0%-1.0%] vs. 0.2% [0.0%-1.3%]; P = 0.003), compared to patients without DM. PFCS level was closely related with diabetic status, showing a positive relationship with glycated hemoglobin level up to 7.0% and then reaching a plateau. In a multivariable analysis, high PFCS phenotype defined as maximal amplitude ≥68 mm (HR: 1.39; 95% CI: 1.07-1.81; P = 0.015) and DM phenotype (HR: 1.38; 95% CI: 1.05-1.79; P = 0.018) were independently associated with MACE occurrence. The presence of diabetic phenotype and high PFCS exhibited an additive effect on MACE occurrence (HR: 2.49; 95% CI: 1.77-3.51; P < 0.001).
Conclusions
In percutaneous coronary intervention–treated patients, diabetic status and clot-strength value were significantly correlated. High clot-strength phenotype increased the risk for MACE, irrespective of diabetic phenotype. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529)
논문정보
- Research article
- 2025년 03월 (BRIC 등록일 2025-03-31)
- 국내 연구진
- 의약학 > 응용의학
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