Will diabetes save the platelet blockers?

More than 30 000 patients have been enrolled in trials assessing the efficacy of glycoprotein (GP) IIb/IIIa inhibitors in unstable angina (UA) or non– ST-segment elevation MI (NSTEMI). The initial trials demonstrated that the use of a GP IIb/IIIa inhibitor resulted in a significant decrease in the rate of death or nonfatal myocardial infarction.1,2 More recently, however, the GP IIb/IIIa inhibitor with the best track record to date in the setting of percutaneous coronary intervention (PCI), abciximab, was tested in UA/NSTEMI in the Global Use of Strategies To Open occluded coronary arteries in Acute Coronary Syndromes (GUSTO IV–ACS) trial, which enrolled patients in whom PCI was not intended, and showed no benefit.3 These disappointing results may have been related to issues of dosing, patient selection, and trial design, but nevertheless, they have led to a reappraisal of the utility of GP IIb/IIIa inhibitors in UA/NSTEMI.