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To the Editor: Mehilli et al1 reported that abciximab did not reduce death or myocardial infarction after percutaneous intervention in diabetics pretreated with a 600-mg loading dose of clopidogrel, but that it reduced restenosis in the subgroup treated with bare-metal stents (BMS). We previously reported that abciximab was not associated with a reduction of in-stent intimal hyperplasia measured by intravascular ultrasound in patients with diabetes treated with BMS. In-stent volume obstruction, a surrogate for in-stent restenosis, did not differ between patients with diabetes treated with or without abciximab.2 In an attempt to reconcile these data, we found that some aspects of the ISAR-SWEET study need to be clarified. First, the analysis of restenosis was done on a per-lesion basis rather than on a per-patient basis. The statistical tests used assumed that lesions within the same patient are independent for restenosis. We learned from Kastrati et al,3 however, that there is an interlesion dependence of restenosis in patients who undergo multilesion intervention (the probability of restenosis for a lesion being higher when a companion lesion has also developed restenosis). Hence, it follows that the correlation among lesions within patients had to be considered and an alternative statistical model that takes into account the correlations applied (eg, linear mixed-effect models). Second, the angiographic results were presented for the groups …

Background— In diabetic patients in the Evaluation of Platelet IIb/IIIa Inhibitor for Stenting (EPISTENT) trial, abciximab reduced target vessel revascularization by ≈50% compared with placebo. Whether this is a result of a lower restenosis rate caused by inhibition of intimal hyperplasia remains to be defined. Methods and Results— The purpose of this study was to determine whether abciximab at the time of stent implantation would reduce in-stent intimal hyperplasia measured by intravascular ultrasound at 6-month follow-up in type 2 diabetics. Ninety-six diabetic patients (96 lesions) who underwent elective stent implantation for a de novo lesion in a native coronary artery were randomly assigned to receive abciximab or no abciximab. In-stent intimal hyperplasia volume, expressed as percentage of stent volume, did not differ between groups: 41.3±21.0% for those treated with abciximab versus 40.5±18.3% for those treated without abciximab ( P =0.9). There were also no significant differences in angiographic minimal luminal diameter at follow-up (1.74±0.69 versus 1.66±0.63 mm; P =0.5), late loss (1.03±0.63 versus 1.07±0.58 mm; P =0.7), restenosis rate (17.8% versus 22.9%; P =0.5), or cumulative incidence of major adverse cardiac events at 12 months (19.1% versus 20.4%; P =0.9). Conclusions— Six-month intravascular ultrasound volumetric analysis showed that abciximab, at the time of coronary stent implantation, was not associated with a reduction of in-stent intimal hyperplasia in diabetic patients.