Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on outcomes of diabetic patients undergoing percutaneous coronary interventions using sirolimus-eluting stents
Eugenia Nikolsky
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorDavid R. Holmes
Mayo Clinic College of Medicine, Rochester, MN, USA
Search for more papers by this authorCorresponding Author
Roxana Mehran
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Columbia University Medical Center, The Cardiovascular Research Foundation, 55 E. 59th St., 6th Floor, New York City, NY 10022Search for more papers by this authorGeorge Dangas
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorErick Schampaert
Hopital Sacre-Coeur de Montreal, Montreal, PQ, Canada
Search for more papers by this authorMarie-Claude Morice
Institut Cardiovasculaire Paris Sud, Massy, France
Search for more papers by this authorJoachim Schofer
Centre for Cardiology and Vascular Intervention, Hamburg, Germany
Search for more papers by this authorMartin Fahy
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorYingbo Na
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorDennis J. Donohoe
Cordis Corporation, Warren, NJ, USA
Dr. Donohoe is a full-time employee of Johnson & Johnson. Dr. Moses owns common stock in and has served as a consultant to and speaker for Johnson & Johnson. Dr. Leon owns equity in, has received research grants from, and serves as a consultant to Johnson & Johnson.
Search for more papers by this authorJeffrey W. Moses
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorMartin B. Leon
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorEugenia Nikolsky
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorDavid R. Holmes
Mayo Clinic College of Medicine, Rochester, MN, USA
Search for more papers by this authorCorresponding Author
Roxana Mehran
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Columbia University Medical Center, The Cardiovascular Research Foundation, 55 E. 59th St., 6th Floor, New York City, NY 10022Search for more papers by this authorGeorge Dangas
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorErick Schampaert
Hopital Sacre-Coeur de Montreal, Montreal, PQ, Canada
Search for more papers by this authorMarie-Claude Morice
Institut Cardiovasculaire Paris Sud, Massy, France
Search for more papers by this authorJoachim Schofer
Centre for Cardiology and Vascular Intervention, Hamburg, Germany
Search for more papers by this authorMartin Fahy
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorYingbo Na
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorDennis J. Donohoe
Cordis Corporation, Warren, NJ, USA
Dr. Donohoe is a full-time employee of Johnson & Johnson. Dr. Moses owns common stock in and has served as a consultant to and speaker for Johnson & Johnson. Dr. Leon owns equity in, has received research grants from, and serves as a consultant to Johnson & Johnson.
Search for more papers by this authorJeffrey W. Moses
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorMartin B. Leon
Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA
Search for more papers by this authorAbstract
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.
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