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Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on outcomes of diabetic patients undergoing percutaneous coronary interventions using sirolimus‐eluting stents
Author(s) -
Nikolsky Eugenia,
Holmes David R.,
Mehran Roxana,
Dangas George,
Schampaert Erick,
Morice MarieClaude,
Schofer Joachim,
Sousa J. Eduardo,
Fahy Martin,
Na Yingbo,
Donohoe Dennis J.,
Moses Jeffrey W.,
Leon Martin B.
Publication year - 2008
Publication title -
catheterization and cardiovascular interventions
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.988
H-Index - 116
eISSN - 1522-726X
pISSN - 1522-1946
DOI - 10.1002/ccd.21548
Subject(s) - medicine , sirolimus , cardiology , percutaneous coronary intervention , percutaneous , platelet , coronary stenting , stent , myocardial infarction , restenosis
Objective: We assessed the outcomes in diabetic patients undergoing percutaneous coronary intervention (PCI) using sirolimus‐eluting stents (SES) as a function of treatment with glycoprotein (GP) IIb/IIIa inhibitors. Methods and Results: Of 551 diabetic patients treated with a SES in nine trials (RAVEL, SIRIUS, E‐SIRIUS, C‐SIRIUS, REALITY, SVELTE, DIRECT, SIRIUS 2.25, and SIRIUS 4.0), 187 patients (33.9%) were administered GP IIb/IIIa inhibitors during PCI. GP IIb/IIIa blockade was associated with lower rates of myocardial infarction (MI) at 30 days (1.1% vs. 3.3%, P = 0.12) and at 1 year (1.1% vs. 4.7%, P = 0.04), and composite endpoint of cardiac death/MI at 1 year (2.2% vs. 6.2%, P = 0.05). Benefit from GP IIb/IIIa inhibitors was confined to 128 insulin‐treated diabetics who had remarkable reduction in MI (0.0% vs. 6.3%, P = 0.04) and cardiac death/MI at 30 days (0.0% vs. 7.6%, P = 0.05) and at 1‐year (0.0% vs. 13.4%, P = 0.01 and 0.0% vs. 15.7%, P = 0.0005, respectively). When treated with GP IIb/IIIa inhibitors, insulin‐requiring diabetics had similar rates of 1‐year death/MI when compared with the nondiabetic patients (0% vs. 4.7%, P = 0.13, respectively). There were no significant differences in outcomes as a function of GP IIb/IIIa blockade in diabetics not treated with insulin. Conclusion: In this analysis, outcomes of insulin requiring diabetic patients undergoing PCI with SES were considerably improved with adjunctive GP IIb/IIIa inhibitors by decreasing the rates of MI and composite endpoint of cardiac death/MI. © 2008 Wiley‐Liss, Inc.