Effects of abciximab and preprocedural glycemic control in diabetic patients undergoing elective coronary stenting.
BACKGROUND
In diabetic patients, the combination of abciximab with stenting has been demonstrated to be the standard of care to reduce target vessel revascularization (TVR) and mortality. Moreover, a preprocedural hyperglycemia has been associated with a higher rate of TVR after an elective stent implantation. We sought to evaluate the effects of abciximab and/or preprocedural glycemic control on 30 and 180 days of TVR and on 1-year major adverse cardiac events (MACE-cardiac mortality, TVR, and myocardial infarction) in diabetic patients undergoing elective coronary stenting.


METHODS
From January 2002 through May 2003, diabetic patients undergoing elective stenting of de novo coronary artery lesions were randomized to abciximab or placebo infusion. Preprocedural hyperglycemia was defined as fasting plasma glucose >or=126 mg/dL (7.0 mmol/L) immediately before the procedure.


RESULTS
A total of 122 consecutive patients with diabetes (62.4 +/- 10.2 years, 80 men) were enrolled in the study. Sixty-nine (56.5%) were randomly assigned to receive abciximab (34 with and 35 without preprocedural hyperglycemia) and 53 (43.5%) to placebo (23 with and 30 without hyperglycemia). Target vessel revascularization was significantly lower in diabetic patients who received abciximab at 30 days (2.9% and 2.8% vs 8.7% and 6.6% in nonabciximab group with or without hyperglycemia, respectively, P < .01) but not at 6 months (31.4% and 26.5% vs 30% and 28.7%, P = NS). Conversely, the cumulative incidence of MACE was significantly higher among diabetic patients with preprocedural hyperglycemia (64.7% and 65.2%) versus diabetic patients with preprocedural glycemic control (37.1% and 40%), treated with or without abciximab, respectively (P < .05).


CONCLUSIONS
A preprocedural hyperglycemia is associated with a higher rate of MACE, regardless of the use of abciximab, in diabetic patients undergoing elective coronary stenting.
De Luca
Leonardo
L
Department of Cardiovascular and Respiratory Sciences, La Sapienza University, Rome, Italy. leodeluca@virgilio.it
De Persio
Giovanni
G
Minati
Monia
M
Iacoboni
Carlo
C
Fedele
Francesco
F
D000077284:Abciximab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D000925:Anticoagulants / Q000627:therapeutic use*; D001786:Blood Glucose; D023921:Coronary Stenosis / Q000401:mortality / Q000628:therapy*; D048909:Diabetes Complications / Q000097:blood / Q000188:drug therapy*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D006943:Hyperglycemia / Q000175:diagnosis*; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D009204:Myocardial Revascularization; D011183:Postoperative Complications / Q000453:epidemiology; D011300:Preoperative Care; D015607:Stents; D013997:Time Factors
D000911:Antibodies, Monoclonal; D000925:Anticoagulants; D001786:Blood Glucose; D007140:Immunoglobulin Fab Fragments; D000077284:Abciximab