Abciximab reduces mortality in diabetics following percutaneous coronary intervention
Abciximab reduces mortality in diabetics following percutaneous coronary intervention
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DOI：
10.1016/s0735-1097(99)00650-6
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发表时间：
2000-03-15
影响因子：
24
通讯作者：
Topol, EJ
中科院分区：
文献类型：
--
作者：
Bhatt, DL;Marso, SP;Topol, EJ
目的 我们试图确定经皮冠状动脉介入治疗 (PCI) 时的阿昔单抗治疗是否会对糖尿病患者的一年死亡率产生有利影响。 背景 众所周知，糖尿病患者在 PCI 后会增加晚期死亡率。 方法 汇总了 PCI、EPIC、EPILOG 和 EPISTENT 三个安慰剂对照试验的数据。将临床诊断为糖尿病的患者的一年死亡率与接受阿昔单抗或安慰剂治疗的非糖尿病患者的一年死亡率进行比较。 结果 在 1,462 名糖尿病患者中，阿昔单抗将死亡率从 4.5% 降低至 2.5%，p = 0.031；在 5,072 名非糖尿病患者中，死亡率从 2.6% 降低至 1.9%，p = 0.099。在患有胰岛素抵抗临床综合征（定义为糖尿病、高血压和肥胖）的患者中，阿昔单抗治疗将死亡率从 5.1% 降低至 2.3%，p = 0.044。使用阿昔单抗可将需要胰岛素的糖尿病患者的死亡率从 8.1% 降低至 4.2%，p = 0.073。使用阿昔单抗，接受多支血管介入治疗的糖尿病患者死亡率从 7.7% 降低至 0.9%，p = 0.018。在 Cox 比例风险生存模型中，与安慰剂相比，使用阿昔单抗的死亡率风险比为 0.642（95% 置信区间 0.458-0.900，p = 0.010）。 结论 阿昔单抗将糖尿病患者的死亡率降低至安慰剂治疗的非糖尿病患者的水平。对于同时患有高血压和肥胖的糖尿病患者以及接受多血管介入治疗的糖尿病患者来说，这种有益效果值得注意。除了其在减少支架糖尿病患者重复干预方面的潜在作用外，阿昔单抗治疗还应在接受 PCI 的糖尿病患者中得到强烈考虑，以提高其生存率。 (C) 2000 年由美国心脏病学会发布。
OBJECTIVES We sought to determine whether abciximab therapy at the time of percutaneous coronary intervention (PCI) would favorably affect one-year mortality in patients with diabetes.BACKGROUND Diabetics are known to have increased late mortality following PCI.METHODS Data from three placebo-controlled trials of PCI, EPIC, EPILOG, and EPISTENT, were pooled. The one-year mortality rate for patients with a clinical diagnosis of diabetes mellitus was compared with the rate for nondiabetic patients treated with either abciximab or placebo.RESULTS In the 1,462 diabetic patients, abciximab decreased the mortality from 4.5% to 2.5%, p = 0.031, and in the 5,072 nondiabetic patients, from 2.6% to 1.9%, p = 0.099. In patients with the clinical syndrome of insulin resistance-defined as diabetes, hypertension, and obesity-mortality was reduced by abciximab treatment from 5.1% to 2.3%, p = 0.044. The beneficial reduction in mortality with abciximab use in diabetics classified as insulin-requiring was from 8.1% to 4.2%, p = 0.073. Mortality in diabetics who underwent multivessel intervention was reduced from 7.7% to 0.9% with use of abciximab, p = 0.018. In a Cox proportional hazards survival model, the risk ratio for mortality with abciximab use compared with placebo was 0.642 (95% confidence interval 0.458-0.900, p = 0.010).CONCLUSIONS Abciximab decreases the mortality of diabetic patients to the level of placebo-treated nondiabetic patients. This beneficial effect is noteworthy in those diabetic patients who are also hypertensive and obese and in diabetics undergoing multivessel intervention. Besides its potential role in reducing repeat intervention for stented diabetic patients, abciximab therapy should be strongly considered in diabetic patients undergoing PCI to improve their survival. (C) 2000 by the American College of Cardiology.