Does reperfusion in the treatment of acute myocardial infarction improve the prognosis of acute myocardial infarction in diabetic patients?
BACKGROUND
Diabetic patients have a 6-fold increased mortality in acute coronary syndromes.


OBJECTIVE
Different therapeutic strategies in diabetics with acute coronary syndromes have an impact on in-hospital and long-term prognosis.


METHODS
A total of 889 consecutive patients with ST-segment elevation myocardial infarction were included and followed-up for at least 6 months. The study population consisted of 168 (18.9%) diabetic patients and 721 nondiabetics.


RESULTS
Invasive therapy and fibrinolysis were less frequently used in diabetic patients (38.7% versus 50.2%; p = 0.0071 and 8.3% versus 15%; p = 0.024, respectively). In-hospital mortality in diabetic individuals was almost twice as high as in nondiabetic subjects (20.2% versus 11.1%; p < 0.0014). In-hospital mortality was slightly higher in diabetic patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA; 8.3% versus 4.8%; p = 0.35), but lower in those treated with fibrinolysis (7.7% versus 16%; p = 0.7) compared with the rest of the patients. At 6-mo follow-up mortality was significantly higher in diabetic subjects as compared with nondiabetic subjects (28.0% versus 15.1%; p < 0.0001). The highest number of deaths was found in individuals receiving conservative treatment with diabetic subjects significantly outnumbering nondiabetic individuals (40.1% versus 27.9%; p = 0.028 at 6 mo). Both in-hospital and 6-mo mortality were similar in diabetics and nondiabetics receiving reperfusion therapy (7.1% versus 8.2%; p < 0.68 and 9.3% versus 15.3%; p < 0.098, respectively).


CONCLUSIONS
Reperfusion therapy, both fibrinolysis and the invasive approach, reduced in-hospital mortality from that observed in nondiabetic individuals.
Janion
Marianna
M
Swietokrzyskie Centrum Kardiologii, Kielce, Poland. mjanion@interia.pl
Polewczyk
Anna
A
Gasior
Mariusz
M
Gierlotka
Marek
M
Poloński
Lech
L
D054058:Acute Coronary Syndrome / Q000401:mortality / Q000628:therapy*; D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality; D016022:Case-Control Studies; D048909:Diabetes Complications / Q000401:mortality / Q000628:therapy*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality / Q000628:therapy*; D018579:Patient Selection; D011044:Poland / Q000453:epidemiology; D012042:Registries; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000401:mortality; D013997:Time Factors; D016896:Treatment Outcome