Stepwise relationship between delay in percutaneous coronary intervention and long-term mortality in patients with non-ST-segment elevation myocardial infarction.

BACKGROUND: Current guidelines recommend coronary catheterization in patients with non-ST- -segment elevation myocardial infarction (NSTEMI) within 24 hours of hospital admission. However, whether there is a stepwise relationship between the time to percutaneous coronary intervention (PCI) and long-term mortality in patients with NSTEMI treated invasively within 24 hours of admission has not been established yet. AIMS: The study aimed to evaluate the association between door-to-PCI time and all-cause mortality at 12 and 36 months in NSTEMI patients presenting directly to a PCI-capable center who underwent PCI within the first 24 hours of hospitalization. METHODS: We analyzed data of patients hospitalized for NSTEMI between 2007-2019, included in the nationwide registry of acute coronary syndromes. Patients were stratified into twelve groups based on 2-hour intervals of door-to-PCI time. The mortality rates of patients within those groups were adjusted for 33 confounding variables by the propensity score weighting method using overlap weights. RESULTS: A total of 37 589 patients were included in the study. The median age of included patients was 66.7 (interquartile range [IQR], 59.0-75.8) years; 66.7% were male, and the median GRACE (Global Registry of Acute Coronary Events) score was 115 (98-133). There were increased 12-month and 36-month mortality rates in consecutive groups of patients stratified by 2-hour door-to-PCI time intervals. After adjustment for patient characteristics, there was a significant positive correlation between the time to PCI and the mortality rates (rs = 0.61; P = 0.04 and rs = 0.65; P = 0.02 for 12-month and 36-month mortality, respectively). CONCLUSIONS: The longer the door-to-PCI time, the higher were 12-month and 36-month all-cause mortality rates in NSTEMI patients.

Prediction of early death after myocardial infarction in patients with reduced left ventricular ejection fraction. The search for new indications for cardioverter-defibrillator implantation (ICD).

BACKGROUND: The highest rate of death is in the first few weeks after myocardial infarction (MI). However, the assessment of indications for primary prevention implantable cardioverter-defibrillator (ICD) implantation should be postponed until at least 40 days after MI. AIMS: Our aim was to identify the subgroup of high-risk patients with reduced left ventricular ejection fraction (LVEF) who would benefit from primary prevention ICD implantation within 40 days of MI. METHODS: Out of 205 606 patients with MI, in this study, we included 18 736 patients treated invasively, with LVEF <40%, who survived until hospital discharge. Patients were divided into two groups according to the survival status at 40 days - patients who died within this period (n = 1331) and patients who survived (n = 17405). RESULTS: Among all patients who died within 12-months after MI, 37.7% did die during the first 40 days. Patients with cardiac arrest before hospital admission or within the first 48 hours of hospitalization (hazard ratio [HR], 3.35; 95% confidence interval [CI], 2.82-3.98; P <0.0001], cardiogenic shock before admission or during hospitalization (HR, 3.06; 95% CI, 2.62-3.59; P <0.0001), unsuccessful percutaneous coronary interventions (PCI; HR, 2.42; 95% CI, 2.11-2.84; P <0.0001), LVEF <20% (ref. LVEF ≥30%; HR, 2.75; 95% CI, 2.25-3.36; P <0.0001) had approximately threefold and patients with chronic kidney disease almost 1.5-times (HR, 1.25; 95% CI, 1.47-3.59; P = 0.0053) higher 40-day mortality compared to patients without these risk factors. The most striking differences in mortality between these subgroups were observed shortly after discharge. CONCLUSIONS: The highest risk of death in patients with reduced LVEF who survived until hospital discharge occurred within the first 40 days after MI. There is a possibility to select patients with the worst prognosis and treat them more aggressively.

Aortic balloon valvuloplasty as a bridge-to-decision in patients with aortic stenosis.

INTRODUCTION: Balloon aortic valvuloplasty (BAV) is a method of treatment for patients who are temporally ineligible for surgical aortic valve replacement (AVR) or transcatheter aortic valve implantation (TAVI). This procedure allows one to select patients with severe left ventricle dysfunction or with symptoms of unknown origin who can benefit from AVR or TAVI. AIM: To evaluate the efficacy, safety and outcome of therapy in patients treated with balloon aortic valvuloplasty. To define clinical characteristics, immediate and distant outcomes of the procedure, and factors affecting the 12-month mortality. MATERIAL AND METHODS: We retrospectively evaluated the procedural and clinical outcomes of 47 consecutive patients with severe, symptomatic aortic stenosis (AS) who underwent balloon aortic valvuloplasty in our center. RESULTS: Age and logistic EuroSCORE were 76.81 ±6.64 and 22.85 ±13.74, respectively. The mean gradient after the procedure decreased from 52.23 ±18.21 to 35.52 ±13.43 mm Hg (p = 0.001). Major complications occurred in 5 (10.6%) patients. In-hospital, 30-day and 1-year mortalities were 6.38%, 10.63% and 42.55%, respectively. 31.9% of patients underwent the destination therapy (TAVI or AVR). One-year mortality in the group treated conservatively after BAV was 56.2%, while in the group treated with AVR or TAVI it was 13.3%. Procedural success, presence of arterial hypertension, and performance of the destination therapy were factors associated with a decreased 1-year mortality. CONCLUSIONS: Balloon aortic valvuloplasty should be treated as a bridge-to-decision on further treatment. Balloon aortic valvuloplasty has high efficacy and an acceptable adverse events rate. Patients undergoing balloon valvuloplasty are high-risk patients with many comorbidities.

In-hospital and long-term prognosis in patients after implantation of implantable cardioverter-defibrillators and cardiac resynchronization therapy: 10-year results of the SILCARD registry.

Introduction During the last 20 years, there has been a considerable increase in the number of implanted implantable cardioverter­defibrillator (ICD) and cardiac resynchronization therapy (CRT) devices. However, there have been only single reports on clinical events, including rehospitalizations, in the long­term follow­up. Objectives We analyzed the baseline clinical characteristics, medical procedures used, and complications of patients with implantation of an ICD or CRT device. Moreover, we analyzed the causes of rehospitalization and the types of treatment used in the 12­month follow­up. Patients and methods Out of 1 208 440 hospitalizations of patients with cardiovascular diseases included in the SILCARD registry, hospitalizations with an ICD­9 code for an ICD or CRT device implantation between 2006 and 2016 were selected. Results The analysis included 12 147 patients with an ICD or CRT device. The total number of hospitalizations was 14 552. Over the years, a significant increase in the number of implanted devices and a higher percentage of CRT defibrillators was observed. Before the implantation, approximately 48.2% of patients underwent revascularization. In­hospital and 12­month mortality rates were 0.4% and 8.1%, respectively. Rehospitalizations due to cardiovascular causes were reported for approximately 40.3% of patients, with a significant reduction in the analyzed period. The most frequent cause of rehospitalization was heart failure (51.4%), while stable coronary artery disease and acute coronary syndromes constituted approximately 16% of the causes. In the 12­month follow­up, nearly every tenth patient was subjected to coronary angiography. Approximately 5% of patients required revascularization. Conclusions The relatively high rates of hospital readmissions and their causes indicate the need for a comprehensive care of patients before implantation of ICD or CRT devices and after discharge.

Nonroutine Use of Intra-Aortic Balloon Pump in Cardiogenic Shock Complicating Myocardial Infarction With Successful and Unsuccessful Primary Percutaneous Coronary Intervention.

OBJECTIVES: The authors sought to compare outcomes of patients with myocardial infarction and cardiogenic shock (CS) treated with percutaneous coronary intervention (PCI) with or without intra-aortic balloon pump (IABP) support according to final epicardial flow in the infarct-related artery. BACKGROUND: A routine use of IABP is contraindicated in patients with myocardial infarction and CS. There are no data regarding the subpopulation of patients who may benefit from such support besides patients with mechanical complications of myocardial infarction. METHODS: Prospective nationwide registry data of patients with myocardial infarction and CS treated with PCI between 2003 and 2014 were analyzed. Patients were initially stratified into 2 groups according to final infarct-related artery Thrombolysis In Myocardial Infarction (TIMI) flow grade after PCI: those with successful primary PCI (TIMI flow grades 2 or 3) and those with unsuccessful primary PCI (TIMI flow grades 0 or 1). Outcomes of patients with or without IABP treatment in each group were analyzed and compared. RESULTS: In the unsuccessful PCI group, patients in whom IABP was applied had lower in-hospital, 30-day, and 12-month mortality. IABP support in this group of patients was an independent predictor of lower 30-day mortality (hazard ratio [HR]: 0.72; 95% confidence interval [CI]: 0.59 to 0.89; p = 0.002). Conversely, in patients with successful PCI, IABP was an independent predictor of higher 30-day mortality (HR: 1.18; 95% CI: 1.08 to 1.30; p = 0.0004). CONCLUSIONS: IABP is associated with a lower risk of 30-day mortality in patients with myocardial infarction complicated by CS, in whom primary PCI was unsuccessful.

Impact of Chronic Total Occlusion of the Coronary Artery on Long-Term Prognosis in Patients With Ischemic Systolic Heart Failure: Insights From the COMMIT-HF Registry.

OBJECTIVES: This study sought to assess the impact of chronic total occlusion (CTO) on long-term prognosis in patients with ischemic cardiomyopathy. BACKGROUND: The presence of concomitant CTO in a nonculprit lesion in acute coronary syndromes is associated with worse prognosis. Coronary artery disease is the main cause of heart failure and in many cases at least 1 CTO is observed. METHODS: The study included all patients with systolic heart failure who underwent elective coronary angiography and were registered from January 2009 to December 2014 in the ongoing single-center COMMIT-HF (COnteMporary Modalities In Treatment of Heart Failure) registry (NCT02536443). The patients were divided into 2 groups with regard to CTO presence. All of the analyzed patients were followed up for at least 12 months with all-cause mortality defined as the primary endpoint. RESULTS: Of the 675 patients fulfilling the inclusion and exclusion criteria, 278 patients (41.2%) had 1 or more CTOs of a major coronary artery (+CTO), and in 397 patients (58.8%) the presence of the CTO was not observed (-CTO). The 12-month mortality for the +CTO and -CTO patients was 19.4 % and 10.3 %, respectively (p < 0.001), evident also after 24 months (26.6% vs. 17.6%; p = 0.01). After a multivariate adjustment for differences in baseline characteristics, the presence of CTO remained significantly associated with higher 12-month mortality (relative risk: 1.84: 95% confidence interval: 1.18 to 2.85; p = 0.006). CONCLUSIONS: Our analysis showed that in patients with ischemic heart failure the presence of the CTO is related to worse long-term prognosis.

Causes of hospitalization and prognosis in patients with cardiovascular diseases. Secular trends in the years 2006-2014 according to the SILesian CARDiovascular (SILCARD) database.

INTRODUCTION Despite the progress in cardiology in recent years, cardiovascular (CV) diseases remain the main cause of death in European countries. The knowledge concerning the structure of hospital admissions for CV diseases and clinical outcomes is fragmentary. OBJECTIVES The aim of the study was to analyze the characteristics and outcome of patients with CV disease, hospitalized between 2006 and 2014 and included in the Silesian Cardiovascular Database (SILCARD) covering a population of 4.6 million patients. PATIENTS AND METHODS SILCARD is based on the data from the Regional Department of the National Health Fund in Poland. The enrollment criteria were any hospitalization at a department of cardiology, cardiac surgery, diabetology or vascular surgery and hospitalization with a cardiovascular diagnosis at a department of internal medicine or intensive care. The data come from 310 hospital departments and 1863 outpatient clinics, and contain information on 487 518 patients and 956 634 hospitalizations. RESULTS Heart failure (20%) and stable coronary artery disease (18.5%) were the most frequent primary causes of hospitalization. The number of hospitalizations due to heart failure, aortic stenosis, and pulmonary embolism significantly increased. The highest 12­month mortality was reported in patients with heart failure and pulmonary embolism (>30%). A decrease in 12­month mortality in patients with heart failure, stable coronary artery disease, myocardial infarction, and atrial fibrillation was noted, although for some disease entities, it remained relatively high. CONCLUSIONS Between the years 2006 and 2014, in­hospital and 12­month mortality showed a trend for decline in many disease entities, with considerable space for prognostic improvement.

The role of balloon aortic valvuloplasty in the era of transcatheter aortic valve implantation.

Balloon aortic valvuloplasty is recommended in patients not suitable for transcatheter aortic valve implantation/aortic valve replacement (TAVI/AVR) or when such interventions are temporarily contraindicated. The number of performed balloon aortic valvuloplasty (BAV) procedures has been increasing in recent years. Valvuloplasty enables the selection of individuals with severe left ventricular dysfunction or with symptoms of uncertain origin resulting from concomitant disorders (including chronic obstructive pulmonary disease [COPD]) who can benefit from destination therapy (AVR/TAVI). Thanks to improved equipment, the number of adverse effects is now lower than it was in the first years after the advent of BAV. Valvuloplasty can be safely performed even in unstable patients, but long-term results remain poor. In view of the limited availability of TAVI in Poland, it is reasonable to qualify patients for BAV more often, as it is a relatively safe procedure improving the clinical condition of patients awaiting AVR/TAVI.

Aspirin 'resistance': impact on no-reflow, platelet and inflammatory biomarkers in diabetics after ST-segment elevation myocardial infarction.

BACKGROUND: The no-reflow (NR) phenomenon exists despite percutaneous coronary intervention (PCI), and is especially prevalent in diabetics. The causes(s) of NR are not fully elucidated, but may be associated with impaired residual platelet and inflammatory reactivity during dual-antiplatelet therapy. OBJECTIVE: To assess the relationship between dual-antiplatelet therapy, NR and conventional biomarkers suggestive of platelet and inflammatory response in diabetics following ST-segment elevation myocardial infarction (STEMI) treated with PCI. METHODS: Sixty diabetics with (n = 27) and without NR (n = 33) were prospectively enrolled. All patients were treated with clopidogrel and aspirin. Platelet and inflammatory biomarkers were assessed serially in the peripheral blood and right atrium before and after PCI and then at 24 h, 7 days and 30 days. RESULTS: Arachidonic acid (AA)-induced platelet aggregation and the serum thromboxane B2 level before and after PCI (in the peripheral and right atrium blood) were significantly higher in the NR patients than in those with no NR. AA-induced aggregation >100 (AUC*min) before PCI predicted NR in diabetic patients with 96.2% sensitivity and 38.5% specificity (AUC 0.66; 95% CI 0.52-0.71; p = 0.029). There were no other correlations between NR and platelet reactivity (collagen, adenosine diphosphate, thrombin receptor agonist peptide-induced aggregation, vasodilator-stimulated phosphoprotein platelet reactivity index, soluble P-selectin, soluble CD40 ligand, platelet-derived growth factor AB and the level of platelet-monocyte aggregates) or between NR and inflammatory indices (i.e. high-sensitivity C-reactive protein, interleukin 6 and interleukin 10). CONCLUSION: An inadequate response to aspirin, but not to clopidogrel, may be associated with the occurrence of the NR phenomenon in diabetics with STEMI who have been treated with primary PCI.

Mechanical circulatory support in cardiogenic shock - what every interventional cardiologist should know.

Cardiogenic shock (CS) remains the main cause of death in patients with myocardial infarction. Conservative treatment alone does not sufficiently improve prognosis. Mortality in CS can only be significantly reduced with revascularization, both surgical and percutaneous. However some patients present with haemodynamic instability despite optimal medical treatment and complete revascularization, resulting in very high mortality rates. These patients require the implementation of mechanical circulatory support in order to increase systemic blood flow, protect against organ hypoperfusion and protect the myocardium through a decrease in oxygen consumption. In contemporary interventional cardiology it seems that every operator should be aware of all available mechanical circulatory support methods for their patients. This article aims to present the current state of knowledge and technical possibilities in this area.

Thrombin generation and platelet reactivity at hospital discharge and 6-month outcome after the acute coronary syndrome in diabetic and nondiabetic patients.

OBJECTIVES: Increased plasma thrombogenesis and blood platelet reactivity are associated with a worse outcome in patients with the acute coronary syndrome (ACS). The aim of this study was to test the clinical utility of combining a thrombin generation test and platelet aggregation in predicting future ischemic events after ACS. METHODS: The study included patients hospitalized due to ST-elevation myocardial infarction (STEMI) treated with primary percutaneous coronary intervention with stent implantation. Blood for platelet aggregation and thrombin generation was collected at hospital discharge. We performed whole-blood platelet aggregation with arachidonic acid (AA), collagen, adenosine diphosphate and thrombin receptor-activating peptide (TRAP) as agonists and the thrombin generation test using a fluorescence method. Patients were followed for up to 6 months. The combined end point of the study consisted of death, stroke, myocardial infarction or repeated target vessel revascularization. RESULTS: The study enrolled 161 patients. The end point occurred in 30 patients (18.6%). Thrombin generation showed a significantly prolonged lag time, time to thrombogram peak and start of the tail of the thrombogram in diabetic patients who reached the study end point but not in nondiabetics. End point occurrence was not connected with platelet reactivity at hospital discharge in the whole group. In the diabetic subgroup, increased platelet aggregation induced with AA and TRAP at hospital discharge was connected with a more frequent occurrence of the study end point. CONCLUSIONS: In diabetic patients after STEMI, thrombin generation measures as well as TRAP- and AA-induced platelet aggregation at hospital discharge are associated with an ensuing ischemic event during the 6-month follow-up.

Comparison between five-year mortality of patients with and without red blood cell transfusion after percutaneous coronary intervention for ST-elevation acute myocardial infarction.

BACKGROUND: Red blood cell (RBC) transfusion can be lifesaving. However, in many clinical cases, including acute coronary syndromes, percutaneous coronary interventions (PCI), cardiac surgery, and acute critical care, detrimental effects (excess death and myocardial infarction [MI], and also lung infections) have been observed in patients after a RBC transfusion. AIM: To evaluate the long-term impact on the prognosis of patients who received a RBC transfusion after PCI for the treatment of ST-segment elevation MI (STEMI). METHODS: Between 1999 and 2004, 2,415 consecutive patients, with an STEMI treated with PCI, were included in the analysis. The patients were divided into two groups: 82 patients with a RBC transfusion (3.5%) and 2,333 without a RBC transfusion (96.5%). RESULTS: The in-hospital mortality rate was 15.8% and 4.2% (p < 0.0001) and the five-year mortality rate was 42.7% and 19% (p < 0.0001) for patients who received and who did not receive a RBC transfusion, respectively. Moreover, multivariate analysis revealed that, after correction for baseline differences, RBC transfusion was an independent predictor of five-year mortality in patients treated with PCI (HR 1.45; 95% CI 1.0-2.1; p = 0.04). CONCLUSIONS: Red blood cell transfusion is associated with higher five-year mortality in STEMI patients treated with PCI.

The influence of diabetes on in-hospital and long-term mortality in patients with myocardial infarction complicated by cardiogenic shock: results from the PL-ACS registry.

BACKGROUND: Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM). AIM: To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group. METHODS: 71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM. RESULTS: The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02). CONCLUSIONS: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.

Effect of glycemic control on response to antiplatelet therapy in patients with diabetes mellitus and ST-segment elevation myocardial infarction.

Impaired glycemic control (GC) is a troubling clinical condition with an unclear prognostic value that is frequent in diabetics, especially in the setting of acute coronary syndrome. Residual platelet reactivity can be also affected by GC. We evaluated the relation between response to dual antiplatelet therapy and GC in diabetics with STEMI treated with primary coronary angioplasty (PCI). Sixty diabetic patients were prospectively enrolled in the study. All patients were treated with clopidogrel and aspirin. Platelet reactivity (whole blood aggregation and phosphorylation of vasodilator-stimulated phosphoprotein, VASP) were assessed serially before and 24 hours, 7 days, and 30 days after the PCI. Blood glucose >8.5 mmol/L on admission was an independent predictor of a impaired clopidogrel response measured with platelet reactivity index (PRI) >50% on admission (OR 7.8, 95% CI 1.4-17.7, p<0.02) and 24 hours after PCI (OR 13.1, 95% CI 3.4-28.1, p<0.01). In conclusion, diabetic patients with STEMI and glycemia >8.5 mmol/L on admission is related to a poorer response to clopidogrel. There were no interaction between glycated hemoglobin level or glycemia on admission and platelet reactivity measured with collagen, arachidonic acid or thrombin receptor agonist peptide-induced aggregation. Further clinical studies of the role of GC in the efficacy of antiplatelet agents are warranted.

Comparison of five-year outcomes of patients with and without chronic total occlusion of noninfarct coronary artery after primary coronary intervention for ST-segment elevation acute myocardial infarction.

The aim of the present study was to evaluate the effect of concurrent chronic total occlusion (CTO) in a noninfarct-related artery (IRA) on the long-term prognosis in patients with ST-segment elevation myocardial infarction and multivessel coronary disease. Of 1,658 consecutive patients with ST-segment elevation myocardial infarction, 666 with multivessel coronary disease who underwent percutaneous coronary intervention from 1999 to 2004 were included in the present analysis. The patients were divided into 2 groups: no CTO and CTO. The first group included 462 patients without CTO (69%) and the second group included 204 patients with CTO in a non-IRA (31%). The in-hospital mortality rate was 6.3% and 21.1% (p < 0.0001) and the 5-year mortality rate was 22.5% and 40.2% (p < 0.0001) for the no-CTO and CTO patients, respectively. Multivariate analysis revealed that after correction for baseline differences CTO in a non-IRA was a strong, independent predictor of 5-year mortality in patients undergoing percutaneous coronary intervention (hazard ratio 1.85; 95% confidence interval 1.35 to 2.53; p = 0.0001). In conclusion, the presence of CTO in a non-IRA in patients with ST-segment elevation myocardial infarction and multivessel coronary disease is a strong and independent risk factor for greater 5-year mortality.

Effects of platelet and inflammatory system activation on outcomes in diabetic patients with ST segment elevation myocardial infarction treated with primary percutaneous coronary intervention.

BACKGROUND: Recurrent myocardial ischaemia and restenosis are more common in diabetic patients treated with primary percutaneous coronary intervention (PCI) due to an acute coronary syndrome (ACS) compared to patients without diabetes. Diabetes is also associated with increased residual platelet activity during dual antiplatelet treatment. In recent reports, platelet reactivity has been linked to outcomes after ACS. Appropriate platelet inhibition might lead to improved outcomes in this patient population. To this end, newest methods to evaluate platelet function may prove helpful. AIM: To evaluate 6-month outcomes in diabetic patients treated with primary PCI due to ST segment elevation myocardial infarction (STEMI) in relation to platelet reactivity evaluated at discharge. METHODS: The study included 120 diabetic patients treated with primary PCI due to STEMI. Patients received loading doses of acetylsalicylic acid (ASA, 300 mg) and clopidogrel (600 mg) on admission, and later were treated with maintenance doses of 75 mg of ASA and clopidogrel. Blood for platelet aggregation testing was collected at discharge. We used whole blood impedance aggregometry using the Multiplate aggregometer with arachidonic acid (AA), adenosine diphosphate (ADP), collagen, and thrombin receptor peptide agonist (TRAP) as agonists. Six-month follow-up was based on telephone contact and hospital discharge summaries if hospitalisation occurred. The primary combined endpoint included recurrent ACS and restenosis. RESULTS: The primary combined endpoint occurred in 28 (23%) patients. Among patients with the primary endpoint, we found significantly higher platelet reactivity as evaluated by aggregation testing using AA and TRAP at discharge following the initial infarction compared to patients without the primary endpoint (area under aggregation curve 1137.4 ± 198.5 vs 833.5 ± 253.4; p = 0.013 for TRAP-induced aggregation, and 333.0 ± 263.8 vs 186.9 ± 105.4; p = 0.019 for AA-induced aggregation). We found no relationship between ADP- and collagen-induced aggregation at discharge and the occurrence of the primary endpoint. CONCLUSIONS: Increased platelet reactivity evaluated by TRAP-induced aggregation is related to a higher rate of restenosis and recurrent ACS during a 6-month follow-up of diabetic STEMI patients treated with PCI.