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(Circulation. 2000;102:2466.)
© 2000 American Heart Association, Inc.

Clinical Investigation and Reports

Glycoprotein IIb/IIIa Receptor Blockade Improves Outcomes in Diabetic Patients Presenting With Unstable Angina/Non–ST-Elevation Myocardial Infarction

Results From the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) Study

Pierre Théroux, MD; Joe Alexander, Jr, MD, PhD; Chantal Pharand, PhD; Eliav Barr, MD; Steven Snapinn, PhD; Asma F. Ghannam, MSN; Frederic L. Sax, MD; on behalf of the PRISM-PLUS Investigators

From the Montreal Heart Institute (P.T.), Montreal, Canada; Merck Research Laboratories (J.A., E.B., S.S., A.F.G., F.L.S.), West Point, Pa; and Centre de Recherche (C.P.), Hôpital du Sacré-Coeur de Montreal, Montreal, Canada.

Correspondence to Pierre Theroux, MD, Montreal Heart Institute, 5000 Belanger St East, Montreal, PQ, Canada H1T 1C8. E-mail theroux{at}ICM.UMontreal.ca

Background—Diabetic patients who present with unstable angina or non–ST-elevation myocardial infarction suffer a substantially greater incidence of subsequent infarction or death compared with nondiabetic patients. The present study was undertaken to examine whether diabetic patients in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study appeared to benefit from platelet glycoprotein IIb/IIIa receptor–mediated inhibition of platelet aggregation by tirofiban.

Methods and Results—Of the 1570 PRISM-PLUS patients treated with either tirofiban plus heparin (n=773) or heparin alone (n=797), 23% in each treatment group were diabetic. A comparison of treatment outcomes in the diabetic subgroup revealed that the combination therapy compared with heparin alone was associated with reductions in the incidence of the composite primary end point of death, myocardial infarction (MI), or refractory ischemia at 2, 7, 30, and 180 days (7.7% versus 8.3%, 14.8% versus 21.8%, 20.1% versus 29.0%, and 32.0% versus 39.9%, respectively; P=NS) and in the incidence of MI or death (0.0% versus 3.1%, P=0.03; 1.2% versus 9.3%, P=0.005; 4.7% versus 15.5%, P=0.002; and 11.2% versus 19.2%, P=0.03). Tests for quantitative interaction between tirofiban therapy and diabetic status were significant.

Conclusions—The addition of tirofiban to heparin and aspirin appears effective in the prevention of major ischemic events, particularly MI or death, in diabetic patients presenting with unstable angina and non–ST-elevation MI.

Key Words: angina • myocardial infarction • diabetes mellitus • glycoproteins • tirofiban

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