title: Benefit of angiographic spontaneous reperfusion in STEMI: does it extend to diabetic patients?
abstract: BACKGROUND
  Spontaneous reperfusion (SR) in ST elevation myocardial infarction (STEMI) improves clinical outcome, yet its incidence and impact among diabetic patients is unclear.
  
  
  OBJECTIVE
  To carry out a systematic analysis of SR in the diabetic cohort of a large primary percutaneous coronary intervention (PCI)-treated population with STEMI.
  
  
  RESULTS
  4944 patients (15.5% diabetic) undergoing primary PCI in the APEX AMI study were evaluated. SR defined as pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow occurred in 11.5% of patients; it was more common in non-diabetic (11.9%) than in diabetic patients (9.2%) (p = 0.028). Patients with SR versus no SR had improved post-PCI TIMI 3 flow: in non-diabetic patients (99.8% vs 90.3%, p<0.001) and in diabetic patients (98.6% vs 84.9%, p<0.001). Non-diabetic patients with SR showed a significant improvement in 90-day death/shock/congestive heart failure (CHF) compared with those without SR: 4.4% versus 8.9% (p = 0.001), respectively. The composite outcome in diabetic patients with versus without SR was 10.0% versus 14.9% (p = 0.270), respectively. When outcomes were examined according to tertiles of baseline blood glucose, both non-diabetic and diabetic patients with normoglycaemia showed higher SR rates (15.5%, 10.3%, 7.3% for non-diabetic patients, p<0.001; 17.4%, 7.2%, 9.1% for diabetic patients, p = 0.132), greater ST resolution (55.4%, 52.6%, 49.7% for non-diabetic patients, p = 0.030; 50%, 46.4%, 39.1% for diabetic patients, p = 0.179), and improved 90-day death/shock/CHF (5.2%, 8.3%, 14% for non-diabetic patients p<0.001; 8.7%, 4.2%, 15.8% for diabetic patients, p = 0.006).
  
  
  CONCLUSIONS
  These data indicate that SR is less common in diabetic patients with STEMI. Diabetic patients without SR have worse post-PCI epicardial patency, which contributes to adverse outcomes. Diabetic patients with normal baseline blood glucose and SR have enhanced epicardial flow after PCI and improved prognosis.
authors.affiliation: University of Alberta, Edmonton, Alberta, Canada.
authors.forename: K R
authors.initials: KR
authors.lastname: Bainey
authors.forename: Y
authors.initials: Y
authors.lastname: Fu
authors.forename: C B
authors.initials: CB
authors.lastname: Granger
authors.forename: C W
authors.initials: CW
authors.lastname: Hamm
authors.forename: D R
authors.initials: DR
authors.lastname: Holmes
authors.forename: W W
authors.initials: WW
authors.lastname: O'Neill
authors.forename: R
authors.initials: R
authors.lastname: Seabra-Gomes
authors.forename: M E
authors.initials: ME
authors.lastname: Pfisterer
authors.forename: F
authors.initials: F
authors.lastname: Van de Werf
authors.forename: P W
authors.initials: PW
authors.lastname: Armstrong
mesh_terms: D000368:Aged; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D017023:Coronary Angiography / Q000379:methods; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D015425:Myocardial Reperfusion / Q000379:methods* / Q000401:mortality; D012075:Remission, Spontaneous; D057127:Single-Chain Antibodies; D016896:Treatment Outcome; D014665:Vasodilator Agents / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D057127:Single-Chain Antibodies; D014665:Vasodilator Agents; C402724:pexelizumab