Franchi F, et al. - In this post hoc analysis of the PLATO trial involving acute coronary syndrome patients, researchers investigated the impact of the combination of diabetes mellitus (DM) and chronic kidney disease (CKD) on cardiovascular outcomes, as well as response to different P2Y₁₂ receptor antagonists. In PLATO, patients were randomized to ticagrelor vs clopidogrel. Overall 15,108 were divided into the following groups: DM+/CKD+ (n=1,058), DM+/CKD− (n=2,748), DM−/CKD+ (n=2,160), and DM−/CKD− (n=9,142). A composite of cardiovascular death, myocardial infarction, or stroke at 12 months was the primary efficacy end point. Major bleeding was considered the primary safety end point. A higher incidence of the primary end point was observed in DM+/CKD+ patients vs DM−/CKD− patients. Based on the presence or absence of DM and CKD, a gradient of risk was evident; the highest risk was reported in those having both risk factors. In all subgroups, an ischemic benefit of ticagrelor over clopidogrel was consistently evident; patients with both DM and CKD demonstrated the greatest absolute risk attenuation.