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Abciximab reduces mortality in diabetics following percutaneous coronary intervention
D L Bhatt1, S P Marso, A M Lincoff
1Department of Cardiology, Cleveland Clinic Foundation, Ohio 44195, USA.
Insights
Abciximab therapy significantly reduces one-year mortality in diabetic patients undergoing percutaneous coronary intervention (PCI). This drug lowers mortality rates to levels comparable to non-diabetic patients, offering improved survival.
Area of Science:
- Cardiology
- Pharmacology
- Clinical Medicine
Background:
- Diabetic patients exhibit elevated late mortality rates after percutaneous coronary intervention (PCI).
- Understanding factors influencing post-PCI outcomes in diabetic populations is crucial for improving patient survival.
Purpose of the Study:
- To evaluate the efficacy of abciximab therapy in reducing one-year mortality among diabetic patients undergoing PCI.
- To compare mortality rates between diabetic and non-diabetic patients receiving abciximab or placebo during PCI.
Main Methods:
- Pooled data from three placebo-controlled PCI trials (EPIC, EPILOG, EPISTENT).
- Comparison of one-year mortality rates in diabetic versus non-diabetic patients treated with abciximab or placebo.
- Analysis included patients with diabetes, insulin resistance, and those undergoing multivessel intervention.
Main Results:
- Abciximab reduced mortality in diabetic patients from 4.5% to 2.5% (p=0.031).
- In patients with insulin resistance (diabetes, hypertension, obesity), abciximab lowered mortality from 5.1% to 2.3% (p=0.044).
- Mortality in diabetic patients undergoing multivessel intervention decreased from 7.7% to 0.9% with abciximab (p=0.018).
Conclusions:
- Abciximab therapy significantly decreases one-year mortality in diabetic patients undergoing PCI.
- The benefits are particularly pronounced in diabetic patients with hypertension and obesity, and those undergoing multivessel intervention.
- Abciximab should be strongly considered for diabetic patients undergoing PCI to enhance survival rates.
Objectives:
We sought to determine whether abciximab therapy at the time of percutaneous coronary intervention (PCI) would favorably affect one-year mortality in patients with diabetes.
Background:
Diabetics are known to have increased late mortality following PCI.
Methods:
Data from three placebo-controlled trials of PCI, EPIC, EPILOG, and EPISTENT, were pooled. The one-year mortality rate for patients with a clinical diagnosis of diabetes mellitus was compared with the rate for nondiabetic patients treated with either abciximab or placebo.
Results:
In the 1,462 diabetic patients, abciximab decreased the mortality from 4.5% to 2.5%, p = 0.031, and in the 5,072 nondiabetic patients, from 2.6% to 1.9%, p = 0.099. In patients with the clinical syndrome of insulin resistance--defined as diabetes, hypertension, and obesity--mortality was reduced by abciximab treatment from 5.1% to 2.3%, p = 0.044. The beneficial reduction in mortality with abciximab use in diabetics classified as insulin-requiring was from 8.1% to 4.2%, p = 0.073. Mortality in diabetics who underwent multivessel intervention was reduced from 7.7% to 0.9% with use of abciximab, p = 0.018. In a Cox proportional hazards survival model, the risk ratio for mortality with abciximab use compared with placebo was 0.642 (95% confidence interval 0.458-0.900, p = 0.010).
Conclusions:
Abciximab decreases the mortality of diabetic patients to the level of placebo-treated nondiabetic patients. This beneficial effect is noteworthy in those diabetic patients who are also hypertensive and obese and in diabetics undergoing multivessel intervention. Besides its potential role in reducing repeat intervention for stented diabetic patients, abciximab therapy should be strongly considered in diabetic patients undergoing PCI to improve their survival.