From Baylor College of Medicine and the Methodist Hospital, Houston, Tex
(N.S.K.); The Carl and Edith Lindner Center for Clinical Cardiovascular
Research and the University of Cincinnati (Ohio) College of Medicine (D.J.K.),
Ischemia Research and Education Foundation, San Francisco, Calif (D.P.M.);
Cleveland (Ohio) Clinic Foundation (A.M.L., E.J.T.); St. Louis (Mo) University
Medical Center (F.V.A.); Centocor Inc, Malvern, Pa (K.M.A., H.F.W.); and Duke
Clinical Research Institute, Durham, NC (R.M.C.).
Background—After angioplasty, major
complications and ischemic events occur more frequently in
diabetic than nondiabetic patients. To determine whether treatment with
abciximab is effective in reducing these events in diabetics, we
analyzed characteristics and outcomes of diabetic patients
enrolled in a large multicenter study (EPILOG).
Methods and Results—Of 2792 patients enrolled, 638 (23%) were
diabetic. Diabetic patients were older, shorter, and heavier; more
likely to be female and have three-vessel disease, prior
coronary artery bypass graft surgery, a history of
hypertension, or a recent myocardial infarction; and less likely to be
current smokers than their nondiabetic counterparts. During
hospitalization, death, myocardial infarction, or urgent
revascularization occurred in 7.1% of diabetics
and 7.5% of nondiabetics. By 6 months, the composite of death and
myocardial infarction had occurred in 8.8% of diabetic patients and
7.4% of nondiabetics, whereas death, myocardial infarction, or
revascularization had occurred in 27.2% and
22.6%, respectively. Abciximab treatment reduced death or myocardial
infarction among diabetic and nondiabetic patients (hazard ratios, 0.28
[95% confidence interval (CI), 0.13 to 0.57] and 0.47 [95% CI,
0.33 to 0.70] at 30 days for diabetics and nondiabetics, respectively,
and 0.36 [95% CI, 0.21 to 0.61] and 0.60 [95% CI, 0.44 to 0.82]
at 6 months for diabetics and nondiabetics, respectively). Abciximab
reduced target vessel revascularization among
nondiabetic patients (hazard ratio, 0.78 [95% CI, 0.63 to 0.96]) but
not among diabetics (hazard ratio, 1.4 [95% CI, 0.94 to 2.08]). When
standard- and low-dose heparin adjuncts were compared, diabetics
receiving abciximab with standard-dose heparin had marginally greater
reductions in the composite of death and myocardial infarction and in
target vessel revascularization than diabetics
assigned to abciximab with low-dose heparin.
Conclusions—Abciximab treatment in diabetic patients led to a
reduction in the composite of death and myocardial infarction, which
was at least as great as that seen in nondiabetic patients. However,
target vessel revascularization was reduced in
nondiabetic but not diabetic patients. This effect may be associated in
part with lower doses of heparin. These differences may be related to
differences in the platelet and coagulation systems between
diabetics and nondiabetics, the greater extent of coronary
artery disease in diabetics, or patient selection and management
factors.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Diabetes Mellitus, Glycoprotein IIb/IIIa Blockade, and Heparin
Evidence for a Complex Interaction in a Multicenter Trial
Key Words: angioplasty • abciximab • diabetes mellitus • revascularization • platelets
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