Platelet glycoprotein IIb/IIIa inhibitors reduce mortality in diabetic patients with Non-ST-segment-elevation acute coronary syndromes

Background-Diabetes mellitus is a major risk factor for adverse outcomes af ter acute coronary syndromes (ACS). Because this disease may be associated with increased platelet aggregation, we investigated whether diabetic patie nts with ACS derive particular benefit from platelet glycoprotein (GP) IIb/ IIIa receptor inhibition. Methods and Results-We performed a meta-analysis of the diabetic population s enrolled in the 6 large-scale platelet GP IIb/IIIa inhibitor ACS trials: PRISM, PRISM-PLUS, PARAGON A, PARAGON B, PURSUIT, and GUSTO IV. Among 6458 diabetic patients, platelet GP IIb/IIIa inhibition was associated with a si gnificant mortality reduction at 30 days, from 6.2% to 4.6% (OR 0.74; 95% C I 0.59 to 0.92; P = 0.007). Conversely, 23072 nondiabetic patients had no s urvival benefit (3.0% versus 3.0%). The interaction between platelet GP IIb /IIIa inhibition and diabetic status was statistically significant (P = 0.0 36). Among 1279 diabetic patients undergoing percutaneous coronary interven tion (PCI) during index hospitalization, the use of these agents was associ ated with a mortality reduction at 30 days from 4.0% to 1.2% (OR 0.30; 95% Cl 0.14 to 0.69; P = 0.002). Conclusions-This meta-analysis, including the entire large-scale trial expe rience of intravenous platelet GP IIb/IIIa inhibitors for the medical manag ement of non-ST-segment-clevation ACS, shows that these agents may signific antly reduce mortality at 30 days in diabetic patients. Although not based on a randomized assessment, the survival benefit appears to be of greater m agnitude in patients undergoing PCI. Therefore, the use of platelet GP IIb/ IIIa inhibitors should be strongly considered in diabetic patients with ACS .