title: Impact of stenting and abciximab in patients with diabetes mellitus undergoing primary angioplasty in acute myocardial infarction (the CADILLAC trial).
abstract: We sought to determine the benefits of stent implantation and abciximab in patients with diabetes mellitus and acute myocardial infarction (AMI) who underwent primary angioplasty. In a 2-by-2 factorial design, 2,082 patients with AMI were randomly assigned to balloon angioplasty versus stenting, with or without abciximab. Diabetes was present in 346 patients (16.6%). The primary end point was the composite incidence of death, disabling stroke, reinfarction, and ischemic target vessel revascularization (TVR). The primary end point at 1 year occurred significantly more frequently in diabetic than nondiabetic patients (21.9% vs 16.8%, p <0.02), driven by increased rates of death (6.1% vs 3.9%, p = 0.04) and TVR (16.4% vs 12.7%, p = 0.07). Among patients with diabetes, TVR at 1 year was significantly reduced with routine stenting compared with balloon angioplasty (10.3% vs 22.4%, p = 0.004), with no differences in death, reinfarction, or stroke. Angiographic restenosis was also greatly reduced in diabetics randomized to stenting (21.1% vs 47.6%, p = 0.009). No beneficial effects were apparent with abciximab in diabetic patients at 1 year. Despite the improved outcomes with stenting in patients with diabetes, 1-year mortality remained increased in diabetic patients who received stents compared with nondiabetics (8.2% vs 3.6%, p = 0.005). Thus, routine stent implantation in diabetic patients with AMI significantly reduces restenosis and enhances survival free from TVR, independent of abciximab use, although survival remains reduced compared with survival in nondiabetic patients regardless of reperfusion modality.
authors.affiliation: LeBauer Cardiovascular Research Foundation and Moses Cone Heart and Vascular Center, Greensboro, North Carolina 27401, USA. tstuckey23@aol.com <tstuckey23@aol.com>
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Stuckey
authors.forename: Gregg W
authors.initials: GW
authors.lastname: Stone
authors.forename: David A
authors.initials: DA
authors.lastname: Cox
authors.forename: James E
authors.initials: JE
authors.lastname: Tcheng
authors.forename: Eulogio
authors.initials: E
authors.lastname: Garcia
authors.forename: John
authors.initials: J
authors.lastname: Carroll
authors.forename: Giulio
authors.initials: G
authors.lastname: Guagliumi
authors.forename: Barry D
authors.initials: BD
authors.lastname: Rutherford
authors.forename: John J
authors.initials: JJ
authors.lastname: Griffin
authors.forename: Mark
authors.initials: M
authors.lastname: Turco
authors.forename: Alexandra J
authors.initials: AJ
authors.lastname: Lansky
authors.forename: Roxana
authors.initials: R
authors.lastname: Mehran
authors.forename: Martin
authors.initials: M
authors.lastname: Fahy
authors.forename: Bruce R
authors.initials: BR
authors.lastname: Brodie
authors.forename: Cindy L
authors.initials: CL
authors.lastname: Grines
mesh_terms: D000077284:Abciximab; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003131:Combined Modality Therapy; D048909:Diabetes Complications / Q000628:therapy*; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000628:therapy*; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000627:therapeutic use*; D015607:Stents
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab