Optimizing percutaneous coronary revascularization in diabetic women: Analysis from the EPISTENT trial

Clinical studies have demonstrated that diabetic women have an increased ri sk of death and nonfatal myocardial infarction (MI) after percutaneous coro nary intervention (PCI). However, there have been few data regarding the ou tcome of diabetic women in the current era of percutaneous coronary revascu larization. Using the Evaluation of Platelet IIb/IIIa Inhibitor for Stentin g Trial (EPISTENT) database, we determined morbidity and mortality for diab etic women undergoing PCT in the current era using stents and the glycoprot ein IIb/IIIa inhibitor, abciximab. There were no mortality differences in t he diabetic women treated with stent-placebo, stent-abciximab, or balloon-a bciximab at 30 days and 6 months. However, the primary end point of 1-year death, MI, or target vessel revascularization (TVR) was lowered in the diab etic women from 34.5% in the stent-placebo group and 28.9% in the balloon-a bciximab group to 13.3% in the stent-abciximab group (p = 0.02 for stent-st ent comparison, and p = 0.09 for stent-abciximab vs, balloon-abciximab comp arison). Also, 1-year TVR rates were lowered from 21.1% in the stent-placeb o group and 26.7% in the balloon-abciximab group to 4.5% in the stent-abcix imab group (p = 0.02 for stent-stent comparison, and p = 0.004 for stent-ab ciximab vs. balloon-abciximab comparison). The combination of stenting and abciximab therapy among diabetic women resulted in a significant reduction in 1-year rate of death, MI, or TVR compared with stent-placebo or balloon- abciximab therapy.