Coronary Artery Disease

Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on outcomes of diabetic patients undergoing percutaneous coronary interventions using sirolimus-eluting stents

  1. Eugenia Nikolsky1,
  2. David R. Holmes2,
  3. Roxana Mehran1,*,
  4. George Dangas1,
  5. Erick Schampaert3,
  6. Marie-Claude Morice4,
  7. Joachim Schofer5,
  8. J. Eduardo Sousa6,
  9. Martin Fahy1,
  10. Yingbo Na1,
  11. Dennis J. Donohoe7,†,
  12. Jeffrey W. Moses1,
  13. Martin B. Leon1

Article first published online: 22 MAY 2008

DOI: 10.1002/ccd.21548

Issue

Catheterization and Cardiovascular Interventions

Catheterization and Cardiovascular Interventions

Volume 71, Issue 7, pages 896–906, 1 June 2008

Additional Information

How to Cite

Nikolsky, E., Holmes, D. R., Mehran, R., Dangas, G., Schampaert, E., Morice, M.-C., Schofer, J., Sousa, J. E., Fahy, M., Na, Y., Donohoe, D. J., Moses, J. W. and Leon, M. B. (2008), Impact of platelet glycoprotein IIb/IIIa receptor inhibitors on outcomes of diabetic patients undergoing percutaneous coronary interventions using sirolimus-eluting stents. Catheterization and Cardiovascular Interventions, 71: 896–906. doi: 10.1002/ccd.21548

Author Information

  1. 1

    Columbia University Medical Center, Center for Interventional Vascular Therapy and the Cardiovascular Research Foundation, New York, NY, USA

  2. 2

    Mayo Clinic College of Medicine, Rochester, MN, USA

  3. 3

    Hopital Sacre-Coeur de Montreal, Montreal, PQ, Canada

  4. 4

    Institut Cardiovasculaire Paris Sud, Massy, France

  5. 5

    Centre for Cardiology and Vascular Intervention, Hamburg, Germany

  6. 6

    Institute Dante Pazzanese, São Paulo, Brazil

  7. 7

    Cordis Corporation, Warren, NJ, USA

  1. †

    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.

*Columbia University Medical Center, The Cardiovascular Research Foundation, 55 E. 59th St., 6th Floor, New York City, NY 10022

Publication History

  1. Issue published online: 22 MAY 2008
  2. Article first published online: 22 MAY 2008
  3. Manuscript Accepted: 26 JAN 2008
  4. Manuscript Received: 12 SEP 2007

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Abstract

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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