Table 4.
Trials of antiplatelet therapy in patients with diabetes mellitus and stable CAD or ACS
| Trial | Setting | Therapy | Primary end point | All patients | Events in all patients (%) | Patients with diabetes | Events in patients with diabetes (%) | Refs |
|---|---|---|---|---|---|---|---|---|
| CAPRIE | Patients at risk of ischaemic events | Aspirin versus clopidogrel | Vascular death, MI, stroke, or hospitalization for ischaemic or bleeding complications at 36 months | 19,185 | 5.8 versus 5.3 (RRR 8.7%, 95% CI 0.3–16.5%) | 3,866 | 17.7 versus 15.6 (RRR 21%, 95% CI NA) | 65 |
| CHARISMA | Stable CAD with high atherothrombotic risk | Aspirin plus clopidogrel versus aspirin | Cardiovascular death, MI, or stroke at 28 months | 15,603 | 6.8 versus 7.3 (RR 0.93, 95% CI 0.83–1.05) | 6,555 | 6.7 versus 7.7 without nephropathy; 11.4 versus 12.0 with nephropathy | 67 |
| CREDO | Elective PCI | Aspirin plus clopidogrel versus aspirin | Death, MI, or stroke at 1 year | 2,116 | 8.3 versus 11.5 (RRR 27.0%, 95% CI 3.9–44.4%) | 560 | NA | 69 |
| CURE | Unstable angina or NSTEMI | Aspirin plus clopidogrel versus aspirin | Cardiovascular death, MI, or stroke at 1 year | 12,562 | 9.3 versus 11.4 (RR 0.80, 95% CI 0.72–0.90) | 2,840 | 14.2 versus 16.7 (RR 0.84, 95% CI 0.70–1.02) | 76 |
| TRITON-TIMI 38 | ACS with scheduled PCI | Aspirin plus prasugrel versus aspirin plus clopidogrel | Cardiovascular death, MI, or stroke at 1 year | 13,608 | 9.9 versus 12.1 (HR 0.81, 95% CI 0.73–0.90) | 3,146 | 12.2 versus 17.0 (HR 0.70, 95% CI 0.58–0.85) | 84 |
| PLATO | ACS | Aspirin plus ticagrelor versus aspirin plus clopidogrel | Cardiovascular death, MI, or stroke at 1 year | 18,624 | 9.8 versus 11.7 (HR 0.84, 95% CI 0.77–0.92) | 4,662 | 14.1 versus 16.9 (HR 0.88, 95% CI 0.76–1.03) | 87 |
| TRILOGY-ACS | Medically managed patients with ACS | Aspirin plus prasugrel versus aspirin plus clopidogrel | Cardiovascular death, MI, or stroke at 30 months | 9,326 | 13.9 versus 16.0 (HR 0.91, 95% CI 0.79–1.05) | 3,539 | 24.0 versus 25.6 (HR 0.95, 95% CI 0.81–1.11) | 85 |
| DAPT | Stable CAD or ACS treated with DES implantation | Aspirin plus clopidogrel or prasugrel versus aspirin | Stent thrombosis, death, MI, or stroke at 30 months | 9,961 | 4.3 versus 5.9 (HR 0.71, 95% CI 0.59–0.85) | 3,391 | 6.6 versus 7.0 (HR 0.92, 95% CI 0.71–1.20) | 91 |
| PEGASUS-TIMI 54 | History of MI (past 1–3 years) | Aspirin plus ticagrelor versus aspirin | Cardiovascular death, MI, or stroke at 36 months | 21,162 | 7.8 versus 9.0 (HR 0.84, 95% CI 0.74–0.95) | 6,806 | 10.0 versus 11.6 (HR 0.83, 95% CI 0.69–1.00) | 93 |
ACS, acute coronary syndrome; CAD, coronary artery disease; DES, drug-eluting stent; MI, myocardial infarction; NA, not available; NSTEMI, non-ST-segment elevation myocardial infarction; PCI, percutaneous coronary intervention; RR, risk ratio; RRR, relative risk reduction.