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

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 (1 year) clopidogrel therapy has been shown to reduce long-term clinical events.10 Recently, the ISAR-REACT (Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment) study found no benefit with abciximab therapy versus placebo in low- and intermediate-risk patients undergoing PCI who …