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(Circulation. 2004;110:3618-3620.)
© 2004 American Heart Association, Inc.

Editorial

Diabetes, Coronary Intervention, and Platelet Glycoprotein IIb/IIIa Blockade

The Triad Revisited

W.H. Wilson Tang, MD; A. Michael Lincoff, MD

From the Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio.

Correspondence to A. Michael Lincoff, MD, Professor of Medicine, Department of Cardiovascular Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, F25, Cleveland, OH 44195. E-mail lincofa@ccf.org

Key Words: Editorials • diabetes mellitus • coronary disease • revascularization • platelet-derived factors

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Diabetes mellitus is associated with inferior outcome after percutaneous coronary intervention (PCI).¹ Platelet glycoprotein IIb/IIIa (GP IIb/IIIa) inhibition is an important adjunctive therapy during PCI and may be particularly so in patients with diabetes mellitus.² Platelet GP IIb/IIIa inhibitors are potent antithrombotic agents, and in several large-scale clinical trials with balloon angioplasty and coronary stenting, these agents have produced a consistent and marked reduction in both 30-day ischemic events and long-term (up to 1 to 3 years) mortality.³ In most cases, a greater magnitude of survival benefit with abciximab has been observed in patients with diabetes as compared with patients without diabetes.^3–5 Furthermore, clinical risk stratification with diabetes and other variables reliably predicts abciximab benefit for late survival, thereby validating the important mortality benefits (nearly 3 lives saved per 100 patients treated) with abciximab use in high-risk patients during PCI.⁶ This large body of evidence has led to the widespread acceptance of platelet GP IIb/IIIa inhibitors to neutralize the excessive mortality associated with PCI among patients with diabetes as compared with patients without diabetes.

See p 3627

The introduction of clopidogrel has changed the landscape of clinical outcomes in PCI. In patients with diabetes, clopidogrel has been shown to be superior to aspirin in reducing recurrent ischemic events.⁷ The use of preprocedural clopidogrel can attenuate the increase in C-reactive protein and other inflammatory markers after PCI, even in the presence of abciximab.^8,9 Pretreatment with clopidogrel (300 to 600 mg) has been suggested to reduce ischemic events during PCI, and long-term . . . [Full Text of this Article]

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Randomized Clinical Trial of Abciximab in Diabetic Patients Undergoing Elective Percutaneous Coronary Interventions After Treatment With a High Loading Dose of Clopidogrel

Julinda Mehilli, Adnan Kastrati, Helmut Schühlen, Alban Dibra, Franz Dotzer, Nicolas von Beckerath, Hildegard Bollwein, Jürgen Pache, Josef Dirschinger, Peter P. Berger, Albert Schömig for the Intracoronary Stenting and Antithrombotic Regimen: Is Abciximab a Superior Way to Eliminate Elevated Thrombotic Risk in Diabetics (ISAR-SWEET) Study Investigators
Circulation 2004 110: 3627-3635. [Abstract] [Full Text]

Randomized Clinical Trial of Abciximab in Diabetic Patients Undergoing Elective Percutaneous Coronary Interventions After Treatment With a High Loading Dose of Clopidogrel

Julinda Mehilli, Adnan Kastrati, Helmut Schühlen, Alban Dibra, Franz Dotzer, Nicolas von Beckerath, Hildegard Bollwein, Jürgen Pache, Josef Dirschinger, Peter P. Berger, Albert Schömig for the Intracoronary Stenting and Antithrombotic Regimen: Is Abciximab a Superior Way to Eliminate Elevated Thrombotic Risk in Diabetics (ISAR-SWEET) Study Investigators
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