title: Impact of diabetes on survival in patients with ST-segment elevation myocardial infarction treated by primary angioplasty: insights from the POLISH STEMI registry.
abstract: BACKGROUND
  It has been shown that, among patients with ST-segment elevation myocardial infarction (STEMI), diabetes is associated with a significantly higher mortality. The aim of this study was to investigate in a large cohort of patients the impact of diabetes on mortality in a large cohort of patients with STEMI treated with primary angioplasty.
  
  
  METHODS
  Our population is represented by consecutive patients with STEMI treated by primary angioplasty and enrolled in the POLISH registry in 2003. All clinical, angiographic, and follow-up data were prospectively collected. Diagnosis of diabetes was based on history of diabetes at admission.
  
  
  RESULTS
  Among 7193 patients, 877 (12.2%) had diabetes at admission. Diabetes was associated with more advanced age (p<0.0001), higher prevalence of female gender (p<0.0001), hyperlipidemia (p<0.0001), shock at presentation (p<0.0001), renal failure (p<0.0001), previous myocardial infarction (p<0.0001), more often treated after 6h from symptom onset (p<0.0001). Diabetes was associated with more extensive coronary artery disease (p<0.0001), less often treated with stenting (p<0.0001). Diabetes was significantly associated with impaired epicardial reperfusion (TIMI 0-2: OR [95% CI]=1.81 [1.5-2.18], p<0.0001), that persisted after correction for baseline confounding factors (OR [95% CI]=1.33 [1.075-1.64], p=0.009). At a mean follow-up of 524+/-194 days, diabetes was associated with higher mortality (unadjusted cumulative mortality: 23.5% vs. 12.6%, unadjusted HR=1.95 [1.66-2.3], p<0.0001), that persisted after correction for confounding factors (adjusted cumulative mortality: 13.3% vs. 10.7%, adjusted HR=1.23 [1.04-1.46], p=0.013).
  
  
  CONCLUSIONS
  This study shows that among STEMI treated by primary angioplasty diabetes is independently associated with impaired epicardial reperfusion and higher mortality.
authors.affiliation: Division of Cardiology, Maggiore della Carità Hospital, Eastern Piedmont University, Novara, Italy. giuseppe.deluca@maggioreosp.novara.it
authors.forename: Giuseppe
authors.initials: G
authors.lastname: De Luca
authors.forename: Lukasz A
authors.initials: LA
authors.lastname: Małek
authors.forename: Paweł
authors.initials: P
authors.lastname: Maciejewski
authors.forename: Wojciech
authors.initials: W
authors.lastname: Wasek
authors.forename: Maciej
authors.initials: M
authors.lastname: Niewada
authors.forename: Bogumił
authors.initials: B
authors.lastname: Kamiński
authors.forename: Janusz
authors.initials: J
authors.lastname: Drze wiecki
authors.forename: Maciej
authors.initials: M
authors.lastname: Kośmider
authors.forename: Jacek
authors.initials: J
authors.lastname: Kubica
authors.forename: Witold
authors.initials: W
authors.lastname: Ruzyłło
authors.forename: Jan Z
authors.initials: JZ
authors.lastname: Peruga
authors.forename: Dariusz
authors.initials: D
authors.lastname: Dudek
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Opolski
authors.forename: Sławomir
authors.initials: S
authors.lastname: Dobrzycki
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Gil
authors.forename: Adam
authors.initials: A
authors.lastname: Witkowski
mesh_terms: D000367:Age Factors; D000368:Aged; D017130:Angioplasty / Q000379:methods; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000401:mortality* / Q000628:therapy*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications*; D011044:Poland; D012042:Registries; D051437:Renal Insufficiency; D016896:Treatment Outcome