The Long-term Clinical Effects of Abciximab in Patients with Acute Myocardial Infarction and Diabetes Undergoing High-risk Percutaneous Coronary Intervention

Kim, Han Gyun; Jeong, Myung Ho; Kim, Weon; Hong, Young Joon; Park, Hyung Wook; Sohn, Il Suk; Kim, Kye Hun; Kim, Ju Han; Ahn, Young Keun; Cho, Jeong Gwan; Hwang, Sun Ho; Kim, Wan; Park, Jong Chun; Kang, Jung Chaee

Abstract

High-risk percutaneous coronary intervention (PCI) is associated with high complication rate and low procedural success rate, especially in diabetics. The purpose of this study is to determine long-term clinical benefits of abciximab in diabetic patients undergoing high-risk PCI with acute ST-elevation myocardial infarction (ASTEMI). All consecutive 126 ASTEMI patients undergoing high-risk PCI with standard dose abciximab therapy from Feb. 1999 and Feb. 2002 were analyzed. The patients were divided into two groups: 35 in diabetic group (Group I, 58.6+/-8.7 years, 29 male) and 91 in non-diabetic group (Group II, 60.6+/-10.4 years, 69 male). MACE [death, myocardial infarction, target lesion revascularization (TLR), coronary artery bypass graft] was evaluated. Baseline clinical characteristics, inflammatory marker, echocardiographic parameter, baseline coronary angiographic characteristics were not different between the two groups. The thrombus containing lesion was 97% and occlusive lesion was 67%. Procedural success was achieved in 91.4% in Group I and 93.4% in Group II. No significant major bleeding event was observed in both groups. No MACE were observed in Group I, but there were 9 (9.9%) in Group II during hospitalization. Five-year clinical follow-up was performed in 124 patients (98.4%). Death occurred in 4 (11.4%) of patients in the Group I and in 9 (9.9%) in the Group II (p=0.51), AMI in 2 (5.7%) and 5 (5.5%), TLR in 11 (31.4%) and 19 (20.9%) (p=0.15) and CABG in 1 (2.9%) and 2 (2.2%). The number of overall MACE were 14 (40.0%) in Group I and 35 (38.5%) in Group II (p=0.51). The clinical outcomes of Abciximab therapy in patients with ASTEMI and diabetes undergoing high-risk PCI are comparable with non-diabetic patients in short- and long-term follow-up.