Abciximab offers greater benefits to insulin-dependent diabetic patients undergoing coronary stent implantation.

INTRODUCTION AND OBJECTIVES: Abciximab use does not exceed 25% in most of the studies on diabetic patients undergoing stent implantation. The aim of this study was to evaluate whether abciximab could be more beneficial in different subgroups such as insulin-dependent (ID) patients and whether its use could provide additional benefits to those afforded by drug-eluting stents in these patients. PATIENTS AND METHODS: A total of 373 consecutive diabetics [223 non-insulin-dependent (NID) and 150 ID patients] who had undergone stent implantation were examined with a follow-up of 25.6+/-16.2 months. Abciximab was used in 21.7%. RESULTS: The abciximab-treated group had a lower rate of revascularization (26.8% vs. 15.8%. P=.02). The results by subgroups were as follows: NID nonabciximab, 23.5%; NID abciximab, 19% (P=NS); ID nonabciximab, 32.7%; ID abciximab, 12.2% (P=.05). In multivariate analysis, the restenosis predictors were insulin dependency (OR, 2.7), abciximab use (OR, 0.18), stent diameter (OR, 0.18). CONCLUSIONS: Abciximab use in diabetics with stent implantation has a favorable effect by reducing the need for new revascularization. This benefit is more evident in ID patients; the negative prognosis effect of being insulin-dependent is eliminated, and the percentage of events in this population over a long follow-up period is equal to those in NID patients.

Clinical and angiographic follow-up in patients with Cypher or Taxus stents in populations with high percentage of trial-excluded lesions.

BACKGROUND: Drug-eluting stents (DESs) are being used in real life in patients with complex lesions usually excluded from the published trials. It is reasonable to think that the results could be worse, and the performance may be different between DES when these complex lesions are included. METHODS AND MATERIAL: To investigate this issue, we studied our first 82 patients with DES (54 patients with Cypher (C) and 28 patients with Taxus (T) (129 lesions, with 1.57 lesions per patient). Seventy-one complex lesions were treated with C stent, 41 with T stent, and 17 with no DES. It was a high-risk population, as reflected by 64% unstable angina and 40% diabetes mellitus. Of the 112 DES complex lesions treated, 38% would have been excluded from the Sirius and Taxus IV trials. RESULTS: The main data on intra-segment angiographic measures showed a late luminal loss lower for the C stent than for the T stent (0.17+/-0.45 and 0.44+/-0.6, P=.02, respectively). The restenosis and target lesion revascularization percentages were also lower for the C stent (8.4% vs. 24.4%, P=.07 and 5.6% vs. 17.1%, P<.05, respectively). In the complex lesions without restenosis, 28% would have been excluded from the trials, while in complex lesions with restenosis, there were 53% (P=.05) (with a homogeneous percentage between the C and T groups). The predictor variables of restenosis in the 112 DES-treated complex lesions were length (P=.03, IC=0.97-1.6) and the pre-reference diameter (P=.06). CONCLUSIONS: In our experience, the C stent is superior to the T stent when treating populations with a high percentage of complex lesions excluded from the trials.

Do myocardial perfusion SPECT and radionuclide angiography studies in adult patients with hypertrophic cardiomyopathy have prognostic implications?

BACKGROUND: Some myocardial perfusion single photon emission computed tomography (SPECT) and radionuclide ventriculography studies have suggested that the presence of regional perfusion defects and diastolic abnormalities could have prognostic implications in patients with hypertrophic cardiomyopathy (HC). The aim of this prospective study was to analyze the prognostic value of these techniques in adult patients with HC. METHODS AND RESULTS: One hundred one patients with HC (44 women; mean age, 54 +/- 16 years; 55% obstructive) were prospectively studied by means of myocardial perfusion SPECT and radionuclide angiography. Of these patients, 55 (54.4%) had an abnormal myocardial perfusion SPECT study: 28 (27.7%) had fixed defects and 41 (40.6%) had reversible defects; 15 (14.8%) of these patients had both types of defect. Of the patients, 16% had left ventricular ejection fraction lower than 60%, 25.7% had an abnormal peak filling rate, and 51% had an abnormal time to peak filling rate. During 5.6 +/- 2.7 years of follow-up, 13 patients (12.8%) died (heart failure 8 and sudden death in 5) and 14 had one or more severe complications develop (syncope in 6, angina III-IV in 4, dyspnea III-IV in 10, and acute myocardial infarction in 3). The summed difference score was higher in patients with cardiac death (2.2 +/- 2.3 vs 1.1 +/- 1.3, P = .008), and fixed defects were more prevalent in patients with severe complications (57% vs 21%, P = .01). In the Kaplan-Meier survival plot analysis, severe complications were more likely in patients with fixed defects (P = .01) or ejection fraction lower than 60% ( P = .01). CONCLUSIONS: Prognostic information from myocardial perfusion SPECT and radionuclide angiography has limited clinical significance with regard to cardiac death in adult patients with HC. However, the presence of fixed defects and lower ejection fraction in these patients has an adverse prognostic meaning for severe complications.

[Neurohormonal prediction of post-infarction ventricular dysfunction and coronary disease]. / Predicción neurohormonal de disfunción ventricular y enfermedad coronaria postinfarto.

Little information is available about the potential role of brain (type B) natriuretic peptide in patients with acute myocardial infarction. We therefore analyzed peptide levels, measured at discharge from our coronary care unit, in 56 patients admitted with a diagnosis of acute myocardial infarction. We examined peptide concentrations in the light of different features in our patients, and found a significant association between natriuretic peptide levels and the two most important prognostic factors: left ventricular ejection fraction, and the severity and extent of coronary disease. Type B natriuretic peptide was a good predictor of these features, and we conclude that concentration of type B natriuretic peptide, measured at discharge from the coronary care unit, provides important clinical and prognostic information in patients with acute myocardial infarction.