Ischemic-hemorrhagic balance in diabetic and non-diabetic patients after acute coronary syndrome

Abstract

Introduction and objectivesBleeding 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. MethodsFrom 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. ResultsIschemic 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. ConclusionsThe 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.