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Vol. 57. Issue 3.
Pages 203-211 (July - September 2022)
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Vol. 57. Issue 3.
Pages 203-211 (July - September 2022)
Original article
Ischemic-hemorrhagic balance in diabetic and non-diabetic patients after acute coronary syndrome
Balance isquémico-hemorrágico en pacientes diabéticos y no diabéticos tras un síndrome coronario agudo
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Luis Manuel Domínguez-Rodrígueza,
Corresponding author
luis-s-ma@hotmail.com

Corresponding author.
, Sergio Raposeiras-Roubína, Emad Abu-Assia, María Cespón-Fernándeza, María Melendo-Viua, Fabrizio D’Ascenzob, Tim Kinnairdc, Albert Ariza-Soléd, Sergio Manzano-Fernándeze, Christian Templinf, Lazar Velickig,h, Ioanna Xanthopouloui, Enrico Cerratoj, Giorgio Quadrik, Andrea Rognonil, Giacome Boccuzzim, Andrea Montabonem, Salma Tahan, Alessandro Duranteo, Sebastiano Gilif, Giulia Magnanif, Michele Autellib, Alberto Grossob, Pedro Flores-Blancoe, Alberto Garayd, Ferdinando Varbellak, Francesco Tommassinik, Diego Gallop, Umberto Morbiduccip, Alberto Domínguez-Rodríguezq, Mariano Valdése, Ángel Cequierd, Fiorenzo Gaitab, Dimitrios Alexopoulosi, Andrés Íñiguez-Romoa
a Departamento de Cardiología, Hospital Universitario Álvaro Cunqueiro, Vigo, Pontevedra, Spain
b Department of Cardiology, Department of Medical Sciences, University of Torino, Turin, Italy
c Department of Cardiology, University Hospital of Wales, Cardiff, Wales, United Kingdom
d Department of Cardiology, Hospital de Bellvitge, L’Hospitalet de Llobregat, Barcelona, Spain
e Departamento de Cardiología, Hospital Clínico Universitario Virgen de la Arrixaca, El Palmar, Murcia, Spain
f Department of Cardiology, University Heart Center, University Hospital Zurich, Zurich, Switzerland
g Medical Faculty, University of Novi Sad, Novi Sad, Serbia
h Institute of Cardiovascular Diseases Voivodina, Sremska Kamenica, Serbia
i Patras University Hospital, Atenas, Rion, Patras, Greece
j Department of Cardiology, San Luigi Gonzaga Hospital, Orbassano, Turin, Italy
k Department of Cardiology, Infermi Hospital, Rivoli, Italy
l Coronary Care Unit and Catheterization Laboratory, AOU Maggiore della Carità, Novara, Italy
m Department of Cardiology, SG Bosco Hospital, Turin, Italy
n Department of Cardiology, Faculty of Medicine, Assiut University, Asiut, Egypt
o Unità Operativa di Cardiologia, Ospedale Valduce, Como, Italy
p PolitoBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
q Departamento de Cardiología, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
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Abstract
Introduction and objectives

Bleeding and ischemic risk after acute coronary syndrome (ACS) is not uniform over time. Our objective was to determine the differences in post-ACS ischemic-hemorrhagic balance between diabetic and non-diabetic patients treated with dual antiplatelet therapy with prasugrel or ticagrelor.

Methods

From 4424 patients enrolled in the RENAMI registry, 1323 (29.9%) had diabetes. The average daily ischemic risk (ADIR) and average daily bleeding risk (ADBR) were defined as the total number of events in that specific time interval divided by the total number of patient-days of follow-up. The ischemic-hemorrhagic balance was calculated as the difference between ADIR and ADBR.

Results

Ischemic and hemorrhagic risks were high in the first 30 days after ACS (ADIR 0.014% in diabetics and 0.012% in non-diabetics; ADBR 0.012% in diabetic and 0.008% in non-diabetic patients) and decreased later. In diabetic patients, the risk of reinfarction is higher than the bleeding risk, especially in the first month (ADIR minus ADBR: +0.002%) and after 6 months (ADIR minus ADBR: 0.007%). However, in non-diabetic patients, the risk of bleeding is higher than the risk of reinfarction, mainly between third and ninth months (ADIR minus ADBR: −0.001%). After propensity score matching, differences found in ischemic-hemorrhagic balance were consistent.

Conclusions

The incidence of both hemorrhagic and ischemic events is higher in the first 30 days. During the first year, in diabetic patients there is a predominance of reinfarction against bleeding. In contrast, in non-diabetic patients, the risk of bleeding is higher than the risk of reinfarction, with the exception of the first 2 and last month.

Keywords:
Acute coronary syndrome
Bleeding
Diabetes
Dual antithrombotic therapy
Resumen
Introducción y objetivos

El equilibrio isquémico-hemorrágico tras un síndrome coronario agudo (SCA) varía durante el seguimiento. Nuestro objetivo es determinar las diferencias en el equilibrio isquémico-hemorrágico en pacientes diabéticos y no diabéticos tratados con ticagrelor o prasugrel tras un SCA.

Métodos

De 4.424 pacientes incluidos en el registro RENAMI, 1.323 (29,9%) eran diabéticos. La tasa media diaria de eventos isquémicos (TMEI) y hemorrágicos (TMEH) se definió como el número total de eventos en dicho periodo de tiempo dividido por el total de pacientes-día en seguimiento. El equilibrio isquémico-hemorrágico se calculó como la diferencia entre TMEI y TMEH.

Resultados

El riesgo de eventos isquémicos y hemorrágicos fue elevado en los 30 primeros días tras un SCA (TMEI 0,014% en diabéticos y 0,012% en no diabéticos; TMEH 0,012% en diabéticos y 0,008% en no diabéticos) y disminuyó posteriormente. En los pacientes diabéticos, el riesgo isquémico era mayor que el hemorrágico, especialmente en el primer mes (TMEI menos TMEH: 0,002%) y a partir del sexto mes (TMEI menos TMEH: 0,007%). Sin embargo, en pacientes no diabéticos, el riesgo hemorrágico supera al riesgo isquémico, principalmente entre el tercer y noveno mes de seguimiento (TMEI menos TMEH: -0.001%). Las diferencias se mantuvieron tras el análisis de propensión.

Conclusiones

La incidencia de eventos isquémicos y hemorrágicos es mayor en los primeros 30 días tras un SCA. En los pacientes diabéticos predomina el riesgo de reinfarto sobre el hemorrágico durante el primer año de seguimiento. Por el contrario, en pacientes no diabéticos, el riesgo hemorrágico supera al riesgo isquémico, con excepción de los 2 primeros y el último mes de seguimiento.

Palabras clave:
Síndrome coronario agudo
Hemorragia
Diabetes
Doble antiagregación plaquetaria

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