title: Primary coronary angioplasty in patients with ST segment elevation acute myocardial infarction and diabetes.
abstract: BACKGROUND
  Subjects with diabetes constitute 13-25% of patients with ST segment elevation acute myocardial infarction (STEMI). In spite of the introduction of thrombolytic therapy, patients with STEMI and diabetes continue to have worse prognosis than those without diabetes. Primary percutaneous coronary intervention (PCI) has been shown in recent years to be the most effective therapy in patients with STEMI.
  
  
  OBJECTIVE
  To compare the outcome of STEMI patients with or without diabetes who underwent primary PCI.
  
  
  METHODS
  The study group consisted of 500 consecutive patients with STEMI. The occurrence of major adverse cardiac events (MACE) which included death, reinfarction or repeated PCI of the target vessel, was analysed peri-operatively and during a six-month follow-up period.Results. Diabetes was diagnosed in 68 (13.6%) patients. The mean time duration from the onset of STEMI symptoms to treatment was similar in patients with or without diabetes (230+/-97 min vs 231+/-139 min, NS). Patients with diabetes were older (61.9+/-8.9 vs 57.9+/-10.8 years, p=0.004), had higher body mass index (29+/-4 vs 27+/-5, p=0.002), more frequent history of coronary artery disease (57.4% vs 37.9%, p=0.002), higher prevalence of arterial hypertension (71.6% vs 56.8%, p=0.02) and more frequently the left anterior descending artery as the infarct-related artery (58.8% vs 42.1%, p=0.01). Immediately after PCI, epicardial and myocardial reperfusion rates were lower in patients with rather than without diabetes (TIMI 3: 84.9% vs 91.3%, p=NS, cTFC: 32+/-26 vs 22+/-16, p<0.0001, and MPG3: 25% vs 41.9% p=0.008). Diabetes increased the risk of MACE during in-hospital period by 2.7 times. The rate of MACE during a six-month follow-up period was almost two times higher in patients with rather than without diabetes (death: 8.8% vs 5.1%, reinfarction: 1.5% vs 1.2%, repeated PCI: 11.8% vs 6.9%).
  
  
  CONCLUSIONS
  Primary PCI-achieved epicardial and myocardial reperfusion rate is lower in STEMI patients with rather than without diabetes. The presence of diabetes almost doubles the risk of MACE during a six-month follow-up.
authors.affiliation: Department of Hemodynamics and Angiocardiography, Institute of Cardiology, Jagiellonian University, College of Medicine, Cracow, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Waldemar
authors.initials: W
authors.lastname: Mielecki
authors.forename: Marcin
authors.initials: M
authors.lastname: Wizimirski
authors.forename: Tomasz
authors.initials: T
authors.lastname: Rakowski
authors.forename: Artur
authors.initials: A
authors.lastname: Dziewierz
authors.forename: Danuta
authors.initials: D
authors.lastname: Sorysz
authors.forename: Marek
authors.initials: M
authors.lastname: Tomala
authors.forename: Cafer
authors.initials: C
authors.lastname: Zorkun
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Zmudka
authors.forename: Jacek S
authors.initials: JS
authors.lastname: Dubiel
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003922:Diabetes Mellitus, Type 1 / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications* / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome