- NEWS . 17 Nov 2019
Patients with stable coronary artery disease and diabetes with previous PCI benefit from long-term DAPT
Patients with stable coronary artery disease and diabetes with previous percutaneous coronary intervention (PCI) should be considered for long-term dual antiplatelet therapy (DAPT). A recent study has demonstrated the benefit of long-term DAPT, particularly in patients who are carefully assessed to be at low bleeding risk and high ischaemic risk, and have tolerated antiplatelet therapy.
The Effect of Ticagrelor on Health Outcomes in diabEtes Mellitus patients Intervention Study (THEMIS) was a phase III randomized, double-blinded, placebo-controlled trial comprising over 20,000 patients, where a prespecified subgroup of patients with previous PCI were followed up. Therefore, the THEMIS-PCI study included 11,154 patients (58% of the overall THEMIS trial) with a history of previous PCI.
Ticagrelor improved net clinical benefit: 519/5,558 (9.3%) versus 617/5,596 (11.0%) (hazard ratio, 0.85; 95% confidence interval, 0.75–0.95; p=0.005), in contrast to patients without PCI where it did not (pinteraction=0.012). Benefit was present irrespective of time from most recent PCI.
In patients with diabetes, stable coronary artery disease and previous PCI, ticagrelor added to aspirin reduced cardiovascular death, myocardial infarction and stroke, although with increased major bleeding. In that large, easily identified population, ticagrelor provided a favourable net clinical benefit (more than in patients without history of PCI). This effect shows that long-term therapy with ticagrelor in addition to aspirin should be considered in patients with diabetes and a history of PCI who have tolerated antiplatelet therapy and have high ischaemic risk and low bleeding risk.
Bhatt DL, et al. Ticagrelor in patients with diabetes and stable coronary artery disease with a history of previous percutaneous coronary intervention (THEMIS-PCI): a phase 3, placebo-controlled, randomised trial. Lancet 2019;394:1169-1180.