[Does abciximab improve the prognosis of diabetics after percutaneous coronary intervention?].
OBJECTIVE
It is known that the outcome of percutaneous coronary intervention is worse in diabetics than in non-diabetics. The aim of our study was to determine whether abciximab therapy could improve clinical outcome in an unselected diabetic population that underwent percutaneous coronary interventions.


METHODS
We analyzed retrospectively 198 diabetic patients who underwent PTCA from January 1997 to January 2000. Seventy-three patients (36.7%) were treated with abciximab and the remaining 125 patients (63.3%) did not receive abciximab. The mean follow-up was 12.6 months. The events considered were death, non-fatal myocardial infarction, any revascularization procedure (including the target vessel), and hospital admission for unstable angina.


RESULTS
Patients who received abciximab had more frequent previous myocardial infarction (67.1 vs. 52.8%; p = 0.04), worse left ventricular function (0.53 vs. 0.59%; p = 0.02), more frequent angiographic thrombus (67.1 vs. 36.8%; p < 0.001), more complex lesions (B2/C) (76.4 vs. 55.8%; p = 0.004), and less frequent location in left anterior descending artery (34.2 vs. 60.8%; p = 0.002). The indication for PTCA in patients who received abciximab was most often related to myocardial infarction. There were no differences between the groups in sex, age and distribution of diabetes treatment. Events were more frequent in diabetics not treated with abciximab than in those who were treated with abciximab (38 vs. 22%; p < 0.037). The patients not treated with abciximab suffered more frequently target vessel revascularization (22.7 vs. 7.2%; p < 0.007). There were no significant differences in the frequency of death or non-fatal myocardial infarction, but hospital readmissions for unstable angina were significantly more frequent in diabetics not treated with abciximab (29.1 vs. 15.9%; p = 0.045). Multivariate analysis identified abciximab as a predictor of the absence of complications during follow-up (OR: 0.45; p = 0.03).


CONCLUSIONS
Abciximab treatment seems to reduce events in unselected diabetic patients undergoing percutaneous coronary intervention, particularly target vessel revascularization.
Servicio de Cardiología, Hospital Clínico Universitario Virgen de la Victoria, Málaga, Spain. Hemoschum@hotmail.com
José María
JM
Hernández García
Antonio
A
Domínguez Franco
Manuel F
MF
Jiménez-Navarro
Juan H
JH
Alonso Briales
Emilio
E
Curiel Balsera
Juan J
JJ
Gómez Doblas
Eduardo
E
De Teresa Galván
D000077284:Abciximab; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis; D015906:Angioplasty, Balloon, Coronary / Q000401:mortality; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D016009:Chi-Square Distribution; D002986:Clinical Trials as Topic; D017023:Coronary Angiography; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000175:diagnosis; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors*; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016277:Ventricular Function, Left
D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab