Ndei Cardiovascular Disease In Diabetes Prothrombotic Milieu
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Diabetes: A Prothrombotic Milieu
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Transcript of Ndei Cardiovascular Disease In Diabetes Prothrombotic Milieu
Diabetes: A Prothrombotic Milieu
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GUSTO-I: Reocclusion After Successful Thrombolysis
40.337.6
0
10
20
30
40
50
TIMI 3 at 90 min
Pa
ten
cy
ra
te (
%)
Data from Woodfield SL et al. J Am Coll Cardiol. 1996;28:1661-1669.
9.2
5.3
0
2
4
6
8
10
After 5-7 days
Diabetes
No diabetes
GUSTO-I=Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries; TIMI 3=Thrombolysis in Myocardial Infarction flow grade 3.
Re
occ
lusi
on
rat
e (
%)
P=0.7
P=0.17
Diabetes No Diabetes
Lipid-rich atheroma 7 ± 2% 2 ± 1% 0.01
Macrophages 22 ± 3% 12 ± 1% 0.003
Thrombus 62% 40% 0.04
Moreno PR et al. Circulation. 2000;102:2180-2184.
Diabetes
Atherectomy tissue immunostained with anti-human pan-macrophage antibody
Composition of Coronary Atherectomy Specimens
P
No Diabetes
GP IIb/IIIa Inhibitors at Time of Angioplasty: EPIC, EPILOG, EPISTENT
1-Y
ear
mo
rtal
ity
(%)
Placebo
Abciximab
*P=0.01; †P=0.099; ‡P=0.031.
Data from Bhatt DL et al. J Am Coll Cardiol. 2000;35:922-928.
2.63.1
4.5
1.92.02.5
0
1
2
3
4
5
All (N=6,534)
No diabetes(N=5,072)
Diabetes (N=1,462)
26% RR
44% RR
*†
‡
Effects of Coronary Stenting on Restenosis and Occlusion in Diabetes
Data from Van Belle E et al. J Am Coll Cardiol. 2002;40:410-417.
Balloon
Stent
13
62
4
27
0
10
20
30
40
50
60
70
Restenosis Occlusion
Pa
tie
nts
wit
h s
ten
os
is >
50%
a
t 6-
mo
fo
llow
-up
(%
)
*
†
*P<0.0001; †P<0.005.
Effects of Coronary Stenting on Cardiac Death and MI in Diabetes
Van Belle et al. J Am Coll Cardiol. 2002;40:410-417.
Stent
Balloon
Years0 1 2 3 4
P=0.02
10
0
Inci
den
ce
of
car
dia
c
de
ath
/no
nfa
tal M
I (%
)
5
15
20
25
30
40% RR
SIRIUS: Effects of Sirolimus-Coated Stents on Restenosis Rates
Data from Moussa I et al. Circulation. 2004;109:2273-2278.* P<0.001.
Uncoated
Sirolimus-coated
Pa
tie
nts
wit
h in
-le
sio
n
res
ten
os
is (
%)
0
10
20
30
40
50
60
50.5
17.6
Diabetes
65% RR30.7
6.0
No diabetes
80% RR
*
*
Time (days)
Pro
bab
ility
of
free
do
m
fro
m e
ven
t
PCI=percutaneous coronary intervention.Kabbani SS et al. Circulation. 2001;104:181-186.
Incidence of Cardiac Events in Patients Undergoing PCI
0 30 60 90
0.6
0.7
0.8
0.9
1.0
P=0.01
Low Platelet Reactivity Group
High Platelet Reactivity Group
Keating FK et al. Am J Cardiol. 2003;92:1362-1365.
The Influence of Glucose on Platelet Function
Per
cen
tag
e o
f p
late
lets
b
ind
ing
fib
rin
og
en
Capacity to Bind Fibrinogen
*P<0.05 for trend by repeated measures ANOVA.ADP=adenosine diphosphate.
Concentration of ADP (mol/L)
Control (no added glucose)27.5 mmol/L glucose55 mmol/L glucose60
40
20
0
*
*
*
0 0.2 1
Keating FK et al. Am J Cardiol. 2003;92:1362-1365.
The Influence of Glucose on Platelet Function (cont.)P
erce
nta
ge
of
pla
tele
ts
exp
ress
ing
P-s
elec
tin
P-Selectin Expression
*P<0.05 for trend and for all glucose concentrations compared with control.
Concentration of ADP (mol/L)
60
40
20
0
*
**
Control (no added glucose)27.5 mmol/L glucose55 mmol/L glucose
0 0.2 1
Mortality in Patients With Diabetes and Non–ST-Segment Elevation ACS
Meta-analysis: PURSUIT PRISM PRISM-PLUS GUSTO IV PARAGON A PARAGON B
6.2
4.6
3.0 3.0
0
1
2
3
4
5
6
7
Diabetes No diabetes
Placebo
GP IIb/IIIa inhibition
30-
Day
mo
rta
lity
(%)
Data from Roffi M et al. Circulation. 2001;104:2767-2771.
P=0.007
P=0.99
ACS=acute coronary syndrome.
Adapted from Mehta SR et al. Lancet. 2001;358:527-533.
PCI-CURE: Pretreatment With Aspirin and Clopidogrel Subgroup Analysis*
Diabetes 16.5% 12.9% 0.77 (0.48-1.22)
No diabetes 11.7% 7.9% 0.66 (0.50-0.87)
RR (95% CI)Placebo† Clopidogrel†
Placebo Better
Clopidogrel Better
Relative Risk
0.2 1.0 1.4
*CV death or MI at 1 year.†In combination with standard therapy.PCI-CURE=percutaneous coronary intervention-Clopidogrel in Unstable angina to prevent Recurrent Events.
Please visit ndei.org to download these slides.
–Website registration is free and takes just a minute or two.
–All slide downloads are free
These slides are available for download from www.ndei.org
