Emerging concepts in the management of acute myocardial infarction in patients with diabetes mellitus.
Although fibrinolysis has improved survival of patients after myocardial infarction (MI), such therapy is less likely to be administered to patients with diabetes. Furthermore, these patients present later (15 min) than nondiabetics. Moreover, even with the use of early potent fibrinolytic agents, patients with diabetes continued to suffer excessive morbidity and mortality. This finding is not related to the ability of fibrinolytic agents to restore complete reperfusion or increased risk of reocclusion of the infarct-related artery. Instead, the impaired ventricular performance at the noninfarct areas and metabolic derangements during the acute phase of MI may account for the adverse outcome. The efficacy of percutaneous coronary revascularization procedures for treatment of acute MI requires further evaluation. Therapeutic approaches should consider correcting these abnormalities to afford greater survival benefit for this subset of high-risk patients.
Mak
K H
KH
Department of Cardiology, National Heart Centre, Singapore.
Topol
E J
EJ
D015906:Angioplasty, Balloon, Coronary; D002314:Cardioplegic Solutions / Q000008:administration & dosage / Q000627:therapeutic use; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy / Q000401:mortality; D004359:Drug Therapy, Combination; D005343:Fibrinolytic Agents / Q000627:therapeutic use*; D005947:Glucose / Q000008:administration & dosage / Q000627:therapeutic use; D006801:Humans; D007262:Infusions, Intravenous; D007328:Insulin / Q000008:administration & dosage / Q000627:therapeutic use; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality / Q000628:therapy*; D011188:Potassium / Q000008:administration & dosage / Q000627:therapeutic use; D015996:Survival Rate; D015912:Thrombolytic Therapy; D016896:Treatment Outcome
D002314:Cardioplegic Solutions; D005343:Fibrinolytic Agents; D007328:Insulin; C030396:glucose-insulin-potassium cardioplegic solution; D005947:Glucose; D011188:Potassium