It was the study objective to determine whether glycaemic control affects the extent of platelet inhibition by
thienopyridines as assessed by
vasodilator-stimulated phosphoprotein flow cytometry (VASP-FCT) in patients with
diabetes mellitus (DM) undergoing
percutaneous coronary intervention (PCI) during
acute coronary syndrome (ACS). Although the proportion of high on-treatment residual platelet reactivity is higher in DM, the contributions of glycaemic control and other factors associated with DM, such as excess
body weight and
inflammation, to this impaired platelet inhibition by
thienopyridines have not yet been fully characterised. In this study, the extent of P2Y12
ADP receptor pathway inhibition was evaluated by the VASP-FCT. Platelet activation was expressed as the platelet reactivity index (PRI). Low response to
clopidogrel (LR) was defined as a PRI of >61%. Four hundred forty-five consecutive ACS patients (DM = 160, NDM = 285) were enrolled. The proportion of LR was higher in DM patients (50 vs. 37.5%). In DM, PRI was not correlated with glycosylated haemoglobin (HbA1c) or glycaemia. In a univariate analysis, LR was associated with age, male sex,
overweight, and white blood cell count (WBC). In a multivariate analysis, WBC >10,000 and
body weight >80 kg were the sole independent predictors of LR to
clopidogrel (hazard ratio (HR) 3.02 [1.36-6.68], p=0.006 and HR 2.47 [1.14-5.35], p = 0.021, respectively). Conversely, in non-DM patients,
ST-elevation myocardial infarction was the sole independent predictor of LR. In conclusion, in ACS DM patients undergoing PCI, the extent of P2Y12 inhibition by
clopidogrel is not related to glycaemic control but is related to
body weight and inflammatory status as assessed by the WBC.