title: Impact of abciximab on prognosis in diabetic patients undergoing primary percutaneous coronary intervention.
abstract: BACKGROUND
  The impact of diabetes in patients with acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (PCI) is unclear. The benefit of abciximab in this subset of patients remains controversial.
  
  
  RESULTS
  Three hundred and twenty-seven consecutive and unselected patients with acute AMI treated with primary PCI were included in our single-center retrospective registry, 103 diabetic (31%) and 224 nondiabetic (69%). Abciximab was given at the physician's discretion. Diabetic patients were older (mean age 68.5±11 vs. 65±12 years; P=0.009), had an increased prevalence of hypertension (73 vs. 54%; P=0.001), a decreased prevalence of smoking (31 vs. 45%; P=0.02), a longer duration of symptoms before hospital admission (190 vs. 143 min; P=0.031), and a higher number of stents implanted (1.4 vs. 1.2; P=0.04). Other clinical and angiographic characteristics were comparable in the two groups. Diabetic patients had a higher incidence of the combined end-point of death and reinfarction rate at 30 days (18 vs. 10%; P=0.04) compared to nondiabetic patients. Abciximab treatment was associated with a lower in-hospital (23.8 vs. 5%; P=0.005) and 30-day (23.8 vs. 6.6%; P=0.012) mortality, and a lower incidence of death and reinfarction at 30 days (33.3 vs. 9.8%; P=0.003) in diabetic patients. In nondiabetic patients, abciximab was not associated with improved outcome measures. Advanced Killip class (III and IV) and abciximab were found to be independently associated with 30-day death or myocardial infarction [respectively, odds ratio (OR) 6.075, 95% confidence interval (CI) 1.59-23.218, P=0.008 and OR 0.177, 95% CI 0.034-0.938, P=0.042] in the propensity score-matched populations of diabetic patients. Advanced Killip class and thrombolysis in myocardial infarction score index were found to be independently associated with 30-day death or myocardial infarction (respectively, OR 6.607, 95% CI 1.5-29.106, P=0.013 and OR 1.094 95% CI 1.042-1.148, P<0.001) in the propensity score-matched populations of nondiabetic patients.
  
  
  CONCLUSIONS
  In our registry diabetic patients treated with primary PCI for AMI had a worse in-hospital and 30-day outcome than nondiabetic patients. Adjunct pharmacologic treatment with abciximab was associated to a better prognosis only in diabetic patients.
authors.affiliation: Struttura Complessa di Cardiologia, Azienda Ospedaliero-Universitaria Ospedali Riuniti di Trieste, Via Valdoni 1, Trieste, Italy. perkan@alice.it
authors.forename: Andrea
authors.initials: A
authors.lastname: Perkan
authors.forename: Giancarlo
authors.initials: G
authors.lastname: Vitrella
authors.forename: Giulia
authors.initials: G
authors.lastname: Barbati
authors.forename: Ariella
authors.initials: A
authors.lastname: De Monte
authors.forename: Bianca
authors.initials: B
authors.lastname: D'Agata
authors.forename: Marco
authors.initials: M
authors.lastname: Merlo
authors.forename: Francesco
authors.initials: F
authors.lastname: Giannini
authors.forename: Erica
authors.initials: E
authors.lastname: Della Grazia
authors.forename: Serena
authors.initials: S
authors.lastname: Rakar
authors.forename: Alessandro
authors.initials: A
authors.lastname: Salvi
authors.forename: Diran
authors.initials: D
authors.lastname: Igidbashian
authors.forename: Tullio
authors.initials: T
authors.lastname: Morgera
authors.forename: Walter
authors.initials: W
authors.lastname: Zalukar
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000627:therapeutic use*; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000628:therapy*; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab