Anti-thrombotic and glucose lowering therapy in diabetic patients with coronary artery disease undergoing PCI with stent implantation: A prospective multicenter observational study on prescription patterns and clinical outcomes. Baseline inclusion data of the ARTHEMIS registry

Abstract

Introduction and objectives

Diabetes is a major determinant of ischemic events after percutaneous coronary intervention (PCI). In a nationwide prospective registry, antiplatelet and glucose-lowering treatment regimens, and two-year clinical outcomes were studied in unselected patients with type 2 diabetes undergoing coronary stent implantation. The current analysis describes the population's baseline characteristics and the prescription patterns of anti-thrombotic and glucose-lowering drugs.

Methods

Between January and November 2021, 1000 patients were enrolled in 12 Portuguese hospitals. In addition to clinical and procedural-related variables, thrombotic (DAPT score) and bleeding risks (PRECISE DAPT) were estimated, and medication (including planned duration of dual antiplatelet therapy) were recorded.

Results

Inclusion rate was relatively high (68.6%) among all eligible patients during the study period (mean age 68±10 years-old, and 70% of male gender). The indication for PCI was an acute coronary syndrome in 58% of cases and 63% had 2–3 vessel coronary artery disease (SYNTAX score 15.6±10.7; mean stent length and diameter 26.3±14.8 and 3.0±1.2 mm, respectively). Of patients not on oral anticoagulation, only 49.8% received potent P2Y12 inhibitors; overall recommendation for shorter DAPT regimens (<6 months,) was 26.5% and did not differ according to low vs. high bleeding risk (24.6% vs. 29.7%; p<0.125). In those also under anticoagulation, 62.6% received a recommendation for <30-day regimens, or no DAPT at all (13.6%). Prolonged DAPT (>12 months) was planned at baseline in 0.7% of the whole cohort and 1.2% of ACS patients. PCI complexity (but not CAD extent) was associated with DAPT duration. Self-reported duration of diabetes was >6 years in 57% (HbA1c 7.6±1.7%) and 12% had known microangiopathy at inclusion. SGLT2 inhibitors (28%) and GLP-1 analogues (3%) were used seldom at admission.

Conclusions

Standard six-to-12-month antiplatelet regimens were the most widely used, largely with acetylsalicylic acid and clopidogrel. DAPT duration was mostly related to PCI complexity and oral-anticoagulation. Metabolic control was off-target and guideline-directed treatment for diabetes was underused at admission (clinicaltrials.gov NCT04481997).