Circulation. 2001;104:2767-2771
doi: 10.1161/hc4801.100029
doi: 10.1161/hc4801.100029
(Circulation. 2001;104:2767.)
© 2001 American Heart Association, Inc.
Clinical Investigation and Reports |
Platelet Glycoprotein IIb/IIIa Inhibitors Reduce Mortality in Diabetic Patients With Non–ST-Segment-Elevation Acute Coronary Syndromes
From the Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio (M.R., D.P.C., D.L.B., J.A.W., D.J.M., E.J.T.); University of Michigan, Ann Arbor (D.M.); Stanford University School of Medicine, Palo Alto, Calif (C.H.); Kerckhoff Heart Centre, Bad Nauheim, Germany (C.W.H.); Duke Clinical Research Institute, Durham, NC (R.M.C.); Green Lane Hospital, Auckland, New Zealand (H.D.W.); Baylor College of Medicine, Methodist Hospital, Houston, Tex (N.S.K.); and Montreal Heart Institute, Montreal, Canada (P.T.).
Correspondence to Eric J. Topol, MD, Department of Cardiovascular Medicine, Desk F25, The Cleveland Clinic Foundation, 9500 Euclid Ave, Cleveland, OH 44195. E-mail topole{at}ccf.org
Background— Diabetes mellitus is a major risk factor for adverse outcomes after acute coronary syndromes (ACS). Because this disease may be associated with increased platelet aggregation, we investigated whether diabetic patients with ACS derive particular benefit from platelet glycoprotein (GP) IIb/IIIa receptor inhibition.
Methods and Results— We performed a meta-analysis of the diabetic populations enrolled in the 6 large-scale platelet GP IIb/IIIa inhibitor ACS trials: PRISM, PRISM-PLUS, PARAGON A, PARAGON B, PURSUIT, and GUSTO IV. Among 6458 diabetic patients, platelet GP IIb/IIIa inhibition was associated with a significant mortality reduction at 30 days, from 6.2% to 4.6% (OR 0.74; 95% CI 0.59 to 0.92; P=0.007). Conversely, 23 072 nondiabetic patients had no survival benefit (3.0% versus 3.0%). The interaction between platelet GP IIb/IIIa inhibition and diabetic status was statistically significant (P=0.036). Among 1279 diabetic patients undergoing percutaneous coronary intervention (PCI) during index hospitalization, the use of these agents was associated with a mortality reduction at 30 days from 4.0% to 1.2% (OR 0.30; 95% CI 0.14 to 0.69; P=0.002).
Conclusions— This meta-analysis, including the entire large-scale trial experience of intravenous platelet GP IIb/IIIa inhibitors for the medical management of non–ST-segment-elevation ACS, shows that these agents may significantly reduce mortality at 30 days in diabetic patients. Although not based on a randomized assessment, the survival benefit appears to be of greater magnitude in patients undergoing PCI. Therefore, the use of platelet GP IIb/IIIa inhibitors should be strongly considered in diabetic patients with ACS.
Key Words: diabetes mellitus • angina • platelets • glycoproteins • angioplasty
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