Glycoprotein IIb/IIIa receptor blockade improves outcomes in diabetic patients presenting with unstable angina/non-ST-elevation myocardial infarction- Results from the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study

Background-Diabetic patients who present with unstable angina or non-ST-ele vation myocardial infarction suffer a substantially greater incidence of su bsequent infarction or death compared with nondiabetic patients. The presen t study was undertaken to examine whether diabetic patients in the Platelet Receptor Inhibition in Ischemic Syndrome Management in Patients Limited by Unstable Signs and Symptoms (PRISM-PLUS) study appeared to benefit from pl atelet glycoprotein IIb/IIIa receptor-mediated inhibition of platelet aggre gation by tirofiban, Methods and Results-Of the 1570 PRISM-PLUS patients treated with either tir ofiban plus heparin (n=773) or heparin alone (n=797), approximate to 23% in each treatment group were diabetic. A comparison of treatment outcomes in the diabetic subgroup revealed that the combination therapy compared with h eparin alone was associated with reductions in the incidence of the composi te primary end point of death, myocardial infarction (MI), or refractory is chemia at 2, 7, 30, and 180 days (7.7% versus 8.3%, 14.8% versus 21.8%, 20. 1% versus 29.0%, and 32.0% versus 39.9%, respectively; P=NS) and in the inc idence of MI or death (0.0% versus 3.1%, P=0.03; 1.2% versus 9.3%, P=0.005; 4.7% versus 15.5%, P=0.002; and 11.2% versus 19.2%, P=0.03). Tests for qua ntitative interaction between tirofiban therapy and diabetic status were si gnificant, Conclusions-The addition of tirofiban to heparin and aspirin appears effect ive in the prevention of major ischemic events, particularly MI or death, i n diabetic patients presenting with unstable angina and non-ST-elevation MI .