Diabetic Status and Thrombogenicity: Association and Prognostic Implications After Percutaneous Coronary Intervention

Abstract

Background: A heightened prothrombotic environment, combined with premature and more aggressive atherosclerosis, contributes to the elevated cardiovascular risk in patients with diabetes mellitus (DM). Objectives: The aim of this study was to evaluate the association between DM status and thrombogenicity and their prognostic implications in patients with significant coronary artery disease. Methods: A total of 2,501 patients with coronary artery disease undergoing percutaneous coronary intervention, with on-admission glycated hemoglobin and thrombogenicity indexes (measured by thromboelastography). Major adverse cardiovascular events (MACE) were defined as a composite of all-cause death, myocardial infarction, or stroke within 4-year follow-up. Results: Patients with DM (n = 970 [38.8%]) demonstrated significantly higher platelet-fibrin clot strength (PFCS), as indicated by maximal amplitude (median [Q1-Q3]: 67.1 [62.2-72.2] mm vs. 65.5 [61.0-70.4] mm; P < 0.001), and reduced fibrinolytic activity, measured by lysis at 30 minutes (median [Q1-Q3]: 0.1% [0.0%-1.0%] vs. 0.2% [0.0%-1.3%]; P = 0.003), compared to patients without DM. PFCS level was closely related with diabetic status, showing a positive relationship with glycated hemoglobin level up to 7.0% and then reaching a plateau. In a multivariable analysis, high PFCS phenotype defined as maximal amplitude ≥68 mm (HR: 1.39; 95% CI: 1.07-1.81; P = 0.015) and DM phenotype (HR: 1.38; 95% CI: 1.05-1.79; P = 0.018) were independently associated with MACE occurrence. The presence of diabetic phenotype and high PFCS exhibited an additive effect on MACE occurrence (HR: 2.49; 95% CI: 1.77-3.51; P < 0.001). Conclusions: In percutaneous coronary intervention–treated patients, diabetic status and clot-strength value were significantly correlated. High clot-strength phenotype increased the risk for MACE, irrespective of diabetic phenotype. (Gyeongsang National University Hospital Registry [GNUH]; NCT04650529) © 2025 American College of Cardiology Foundation