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- CARDia, Coronary Artery Revascularization in Diabetes
- DES, drug-eluting stents
- Gp, glycoprotein
- HR, hazard ratio
- ISAR-REACT, Intracoronary Stenting and Antithrombotic Regimen-Rapid Early Action for Coronary Treatment
- MACE, major adverse cardiac events
- PCI, percutaneous coronary intervention
- RESEARCH, Rapamycin-Eluting Stent Evaluated At Rotterdam Cardiology Hospital
- SES, sirolimus-eluting stents
- TVR, target vessel revascularisation
Patients with diabetes mellitus have an increased risk of cardiac events after percutaneous coronary intervention (PCI). As drug-eluting stents (DES) reduce restenosis and glycoprotein (Gp) IIb/IIIa inhibitors reduce the risk of death and myocardial infarction, the use of both treatments may be complementary and be a powerful tool for reducing cardiac events after PCI in diabetic patients. On the other hand, there are some concerns about the rate of stent thrombosis with DES, and some recent reports have pointed to diabetes as one of the risk factors.1
We therefore tested the hypothesis that Gp IIb/IIIa inhibitors may reduce the rate of major cardiac events after PCI with sirolimus-eluting stents (SES) in patients with diabetes mellitus.
This was a prospective non-randomised single-centre registry, including all consecutive patients with diabetes undergoing PCI with at least one SES at our institution from April 2002 to April 2003.
One-year clinical follow up was assessed in all patients. Patients were divided into two subgroups according to the periprocedural use of Gp IIb/IIIa inhibitors (99 patients in the group with Gp IIb/IIIa inhibitors and 104 in the group without).
The intervention strategy was entirely dependent on the operator and was performed according to standard guidelines. Patients were given a loading dose of 300 mg of clopidogrel immediately after the procedure and were taking aspirin and clopidogrel daily thereafter, for at least three months.
We evaluated a clinical end point defined as the combined incidence of the major adverse cardiac events (MACE) death, non-fatal myocardial infarction and target vessel revascularisation (TVR) at the one-year follow up.
Data were statistically analysed with SPSS V.11.0 software (SPSS Inc, Chicago, Illinois, USA) by χ2 test, Student’s unpaired t test, log rank test and Cox proportional hazards models as appropriate.
Of 1310 patients undergoing PCI …