title: Impact of insulin-requiring diabetes mellitus on effectiveness of reperfusion and outcome of patients undergoing primary percutaneous coronary intervention for acute myocardial infarction.
abstract: The relation between diabetes mellitus (DM) and outcome was assessed in a series of 1,061 patients with acute myocardial infarction (AMI) who underwent primary percutaneous coronary intervention (PCI). The efficacy of reperfusion was assessed by ST-segment resolution analysis. Of 1,061 patients, 166 had DM (15.6%), and 84 had insulin-requiring DM (51% of DM patients). The 6-month mortality rate was 26% in insulin-requiring DM patients, 7% in non-DM patients, and 4% in non-insulin-requiring DM patients (p <0.001). The early ST-segment resolution rate was lower in insulin-requiring DM patients (52%) compared with the other DM patients (78%) and non-DM patients (76%; p <0.001). Multivariate analysis showed insulin-requiring DM to be independently related to the risk for death (hazard ratio 1.94, 95% confidence interval 1.17 to 3.22, p = 0.009). Insulin-requiring DM is a strong predictor of mortality in patients who undergo PCI for AMI, and this relation may be explained by a less effective myocardial reperfusion despite the mechanical restoration of normal epicardial flow in most patients.
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy. carddept@tin.it
authors.forename: David
authors.initials: D
authors.lastname: Antoniucci
authors.forename: Renato
authors.initials: R
authors.lastname: Valenti
authors.forename: Angela
authors.initials: A
authors.lastname: Migliorini
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.forename: Guia
authors.initials: G
authors.lastname: Moschi
authors.forename: Gentian
authors.initials: G
authors.lastname: Memisha
authors.forename: Giovanni Maria
authors.initials: GM
authors.lastname: Santoro
authors.forename: Giampaolo
authors.initials: G
authors.lastname: Cerisano
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015906:Angioplasty, Balloon, Coronary; D003097:Collateral Circulation / Q000502:physiology; D017023:Coronary Angiography; D003326:Coronary Circulation / Q000502:physiology; D003922:Diabetes Mellitus, Type 1 / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D004562:Electrocardiography; D005260:Female; D006083:Graft Occlusion, Vascular / Q000000981:diagnostic imaging / Q000209:etiology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000628:therapy*; D015425:Myocardial Reperfusion; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000209:etiology / Q000401:mortality; D016016:Proportional Hazards Models; D012307:Risk Factors; D016019:Survival Analysis; D016896:Treatment Outcome