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High Biomarker Level Plus Diabetes Predict Bad PCI Outcomes

Researchers published the study covered in this summary on MedRxiv as a preprint that has not yet been peer reviewed.

Key Takeaways

  • Among patients with type 2 diabetes and coronary artery disease (CAD) who underwent percutaneous coronary intervention (PCI), those with a high platelet-to-lymphocyte ratio (PLR) at the time of their procedure had a significantly higher risk for major adverse cardiovascular and cerebrovascular events (MACCE) and stent thrombosis compared with similar patients with a low PLR during a median 2.4-year follow-up.

  • Patients with PCI and a high PLR, but without type 2 diabetes, were not at increased risk for these outcomes compared with similar patients with a low PLR.

Why This Matters

  • PLR is an easy-to-obtain inflammatory biomarker.

  • Results from previous studies that assessed PLR showed that it could be a useful biomarker to gauge disease activity, treatment reaction, and prognosis in inflammatory disorders including solid tumors, arthritis, and acute kidney injury. Evidence also supports the value of PLR for evaluating inflammatory burden and signaling poor prognosis in cardiovascular diseases including ST-elevation myocardial infarction, heart failure, and stable angina.

  • This study provides the first results showing that PLR is an independent risk factor for stent thrombosis over 2 years in patients with PCI and type 2 diabetes.

  • The results suggest that patients with type 2 diabetes and a high PLR should be closely monitored following PCI.

Study Design

  • Researchers identified 8831 adults who underwent PCI using drug-eluting stents at Fuwai Hospital in Beijing, China, in 2013 and who had plasma platelet and lymphocyte counts determined using a blood sample before PCI. 

  • The cohort included 6164 people without diabetes (3015 with a low PLR and 3149 with a high PLR) and 2667 people with type 2 diabetes(1404 with a low PLR and 1263 with a high PLR). The population was divided in half into subgroups with high PLRs (n=4419) or low PLRs (n=4412).

  • The primary outcome was MACCE, a composite of all-cause death, myocardial infarction, stroke, and target vessel revascularization. Stent thrombosis was a secondary outcome.

Key Results

  • During a median 2.4-year follow-up, 663 patients (7.5%) had MACCE and 75 patients (0.85%) had stent thrombosis.

  • Among patients with type 2 diabetes, and after adjustment for multiple potential confounders, those with a high PLR had a significantly higher risk of MACCE compared with those with a low PLR (hazard ratio, 1.53) and stent thrombosis (hazard ratio, 3.79).

  • Among patients without type 2 diabetes, those with a high PLR were not at increased risk for MACCE nor for stent thrombosis, compared with patients with those with a low PLR.


  • This was an observational study with limited data collection, and hence, there may be potential confounders that were not adjusted for.

  • The study lacked data on changes in PLR and glycemic status during follow-up.

  • Participants were exclusively Chinese, and so the findings may have limited generalizability.


  • The study received no commercial funding.

  • None of the authors had relevant financial disclosure.

This is a summary of a preprint research study, “Association of serum platelet-to-lymphocyte ratio levels with the risk of stent thrombosis and long-term prognosis in patients undergoing percutaneous coronary intervention with and without type 2 diabetes mellitus: A large-scale prospective cohort study,” written by researchers from Fuwai Hospital, Beijing, China, on medRxiv and provided to you by Medscape. This study has not yet been peer reviewed. The full text of the study can be found on

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