Synergistic Effects of Diabetes and Smoking on Ticagrelor Antiplatelet Activity in ACS Patients Undergoing PCI

Background: Diabetes and smoking are well-established risk factors that enhance platelet reactivity in acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). Objective: To compare the combined (synergistic), individual effects of smoking and diabetes, and the absence of these risk factors on the antiplatelet efficacy of ticagrelor in ACS patients undergoing PCI. Methods : A total of 400 patients participated in this study. Patients were stratified into four groups based on their smoking and diabetes status: Group I (diabetic Smokers), Group II (diabetic non-smokers), Group III (non-diabetic smokers), and Group IV (non-diabetic non-smokers), with 100 patients in each group. All patients received a 180 mg loading dose of ticagrelor immediately prior to PCI. Maximum platelet aggregation (MPA) and Platelet Reactivity Index (PRI) were assessed at baseline and at four hours post-loading dose administration of ticagrelor to evaluate antiplatelet activity. Results: Baseline characteristics were comparable across all groups except for smoking and diabetes status. Group I (diabetic smokers) had a significantly higher proportion of individuals with high PRI compared to Group II (p=0.002), Group III (p=0.001), and Group IV (p=0.001), with no significant differences between Group II and Group III (p=1.000), Group II and Group IV (p=0.758), or Group III and Group IV (p=0.798). For high MPA, Group I also had significantly higher percentages compared to Group II (p=0.0005), Group III (p<0.0001), and Group IV (p=0.002), with no significant differences between Group II and Group III (p=0.712), Group II and Group IV (p=1.000), or Group III and Group IV (p=0.943). Multivariate logistic regression identified the combination of diabetes and smoking as a significant independent predictor for high PRI (adjusted OR: 2.24; 95% CI: 1.21-4.16; p=0.010) and high MPA (adjusted OR: 2.65; 95% CI: 1.08-6.48; p=0.031). Conclusion : ACS patients who are both smokers and diabetics undergoing PCI may exhibit reduced responsiveness to the antiplatelet effects of ticagrelor, warranting closer clinical attention to optimize their management.