title: Primary stenting in acute myocardial infarction: influence of diabetes mellitus in angiographic results and clinical outcome.
abstract: BACKGROUND
  The outcome of patients with diabetes after myocardial infarction (MI) has traditionally been worse than in their nondiabetic counterparts before and during the thrombolytic therapy era. Whether the fate of patients with diabetes might improve with mechanical intervention, particularly with primary stenting, has not previously been studied.
  
  
  METHODS
  We compared the angiographic and clinical outcome of 76 nondiabetic patients (aged 61 +/- 14 years; 66% male) and 28 patients with diabetes (aged 65 +/- 12 years; 64% male) consecutively treated with primary stenting for acute MI. Coronary Thrombolysis In Myocardial Infarction grade 3 flow was restored in 96% of diabetic and 97% of nondiabetic patients.
  
  
  RESULTS
  Angiographic results after stent deployment were similar in the 2 groups. At 1-month follow-up, all patients in both groups were alive. Patients with diabetes had a much higher incidence of stent thrombosis (18% vs 1%; P =.003), which accounted for the majority of the major cardiac events at 1 month (21% vs 4%; P =.009). At a mean follow-up of 315 +/- 13 days, 99% of nondiabetic and 89% of patients with diabetes were alive (P =.04). Overall freedom from a major cardiac event (death, MI, target vessel revascularization) at 315 +/- 13 day follow-up was 88% for nondiabetics and 54% for patients with diabetes (P =.0003). By multivariate analysis, diabetes mellitus was the most important predictor for development of 1-month (RR 9.89; 95% confidence interval, 1.6-30) and late major cardiovascular events (RR 8.39; 95% confidence interval, 2.93-24).
  
  
  CONCLUSIONS
  Primary stenting in acute MI is highly effective in restoring immediate TIMI 3 coronary flow in nondiabetic patients and patients with diabetes. This procedure may improve benefit in terms of mortality rate to both groups, particularly in patients with diabetes, compared with previous reports with thrombolytic therapy. Nevertheless, stent thrombosis and major cardiovascular events at 1 month and late follow-up are more frequent in patients with diabetes.
authors.affiliation: Department of Cardiology, Ochsner Medical Institutions, New Orleans, LA, USA.
authors.forename: J A
authors.initials: JA
authors.lastname: Silva
authors.forename: S R
authors.initials: SR
authors.lastname: Ramee
authors.forename: C J
authors.initials: CJ
authors.lastname: White
authors.forename: T J
authors.initials: TJ
authors.lastname: Collins
authors.forename: J S
authors.initials: JS
authors.lastname: Jenkins
authors.forename: E
authors.initials: E
authors.lastname: Nunez
authors.forename: S
authors.initials: S
authors.lastname: Zhang
authors.forename: S P
authors.initials: SP
authors.lastname: Jain
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D017023:Coronary Angiography; D003327:Coronary Disease / Q000000981:diagnostic imaging / Q000473:pathology; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000601:surgery*; D015607:Stents; D016019:Survival Analysis; D016896:Treatment Outcome