Hamilos M, et al. - Patients with diabetes mellitus (DM) and those without DM were compared in terms of clinical outcome following percutaneous coronary intervention (PCI) for acute coronary syndrome (ACS). A higher but not significantly higher major adverse cardiovascular events (MACE) rate was reported in diabetic patients, with no difference in bleeding events, in ‘real-life’ ACS undergoing PCI. Among those treated with clopidogrel, a significant difference in MACE was evident, whereas when newer antiplatelet agents were used the negative impact of DM on ischemic events was eliminated.

• A prospective observational study (GRAPE) was carried out, to focus on contemporary antiplatelet use in moderate-risk to high-risk ACS patients receiving PCI.
• Researchers used propensity score adjustment to analyze major adverse cardiovascular events (MACE), (composite of death, nonfatal myocardial infarction, urgent revascularization, and stroke) and bleeding events (Bleeding Academic Research Consortium definition) at 1 year of follow-up.
• They also conducted a subanalysis according to diabetes mellitus (DM) status.

• Diabetes was detected in 469 (22.9%) of 2047 registered patients.
• As per the data, complete 1-year follow-up was available in 95.1% of patients.
• Researchers noted the occurrence of MACE in 12.2 and 7.2% of those patients with and without DM, respectively [adjusted hazard ratio (HR), 95% confidence interval (CI)=1.27 (0.89–1.79), P=0.2].
• They found that in diabetic patients, observed BARC type ≥3 bleeding risk was not higher: adjusted HR (95% CI)=1.20 (0.79–1.84).
• Findings demonstrated that in the subgroup of clopidogrel-treated patients (N=238), diabetic vs nondiabetic cohort had significantly higher MACE rate [13.4 vs 9%, adjusted HR (95% CI)=1.68 (1.07–2.64), P=0.03].
• In addition, results also revealed that in the subgroup of ticagrelor-treated or prasugrel-treated patients (N=228), MACE rate did not differ significantly between diabetic and nondiabetic patients: 9.6 vs 5%, adjusted HR (95% CI)=1.35 (0.77–2.37), P=0.38.