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

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) (JACC Cardiovasc Interv. 2025;18:720-733) (c) 2025 by the American College of Cardiology Foundation.