One-month DAPT after biodegradable-polymer everolimus-eluting stent implantation in diabetic patients at high-bleeding risk: insights from the POEM trial

A shortened dual antiplatelet therapy (DAPT) is indicated in patients at a high bleeding risk (HBR) who undergo percutaneous coronary intervention (PCI), but currently limited knowledge exists on the impact of diabetes on clinical outcomes in these patients.

This study aims to evaluate the association between diabetes and clinical outcomes in patients at HBR who underwent PCI with biodegradable-polymer everolimus-eluting stent (BP-EES) and subsequently followed a short 1-month DAPT strategy.

The POEM trial enrolled HBR patients undergoing PCI with BP-EES and subsequently treated with 1-month DAPT. In this prespecified subgroup analysis we assessed diabetes-associated outcomes according to the intention-to-treat principle. The primary endpoint was a composite of cardiovascular death, myocardial infarction, or definite/probable stent thrombosis at 1 year. Time-to-event outcomes were analyzed using the Kaplan-Meier method and log-rank test, and hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated using Cox regression models.

436 patients were included in the analysis, of whom 166 (38.1%) had diabetes. The primary endpoint occurred in 5.6% in the diabetes group and 4.5% in the non-diabetes group (HR 0.81, 95% CI 0.34-1.91, p=0.62). Similar rates were observed for secondary ischemic endpoints. Bleeding rates were 3.8% and 5.3%, respectively (HR 1.38, 95% CI 0.53-3.59, p=0.51).

Our analysis demonstrated no significant increase in clinical outcomes associated with diabetes, as well as similar ischemic and bleeding rates as non-diabetic patients. These findings support a short DAPT regimen as a feasible strategy after PCI in diabetic patients with HBR.