title: Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era.
abstract: BACKGROUND
  We investigated the association between diabetes mellitus (DM) and all-cause mortality in a large cohort of consecutive patients treated with primary percutaneous coronary intervention (PPCI) in the contemporary era.
  
  
  METHODS
  We conducted a retrospective analysis of a single-centre registry of patients undergoing PPCI for ST-segment elevation myocardial infarction (STEMI) at a large regional PCI centre between 2005 and 2009. All-cause mortality in relation to patient and procedural characteristics was compared between patients with and without DM.
  
  
  RESULTS
  Of 2586 patients undergoing PPCI, 310 (12%) had DM. Patients with DM had a higher prevalence of multi-vessel coronary disease (p<0.001) and prior myocardial infarction (p<0.001). Patients with DM were less commonly admitted directly to the interventional centre (p=0.002). Symptom-to-balloon (p<0.001) and door-to-balloon time (p=0.002) were longer in patients with DM. Final infarct-related-artery TIMI-flow grade was lower in patients with DM (p=0.031). All-cause mortality at 30 days (p=0.0025) and 1 year (p<0.0001) was higher in patients with DM. DM was independently associated with increased mortality after multivariate adjustment for potential confounders.
  
  
  CONCLUSIONS
  Mortality remains substantially higher in patients with DM following reperfusion for STEMI in comparison with those without diabetes, despite contemporary management with PPCI. Greater co-morbidity, delayed presentation, longer times-to-reperfusion, and less optimal reperfusion may contribute to adverse outcomes.
authors: Department of Cardiology, Leeds General Infirmary, Leeds, UK.
authors: Matthew B
authors: MB
authors: Kahn
authors: Richard M
authors: RM
authors: Cubbon
authors: Ben
authors: B
authors: Mercer
authors: Alison C G
authors: AC
authors: Wheatcroft
authors: Guy
authors: G
authors: Gherardi
authors: Amir
authors: A
authors: Aziz
authors: Vivek
authors: V
authors: Baliga
authors: Jonathan M
authors: JM
authors: Blaxill
authors: Jim M
authors: JM
authors: McLenachan
authors: Daniel J
authors: DJ
authors: Blackman
authors: John P
authors: JP
authors: Greenwood
authors: Stephen B
authors: SB
authors: Wheatcroft
mesh_terms: D000368:Aged; D015906:Angioplasty, Balloon, Coronary / Q000009:adverse effects / Q000401:mortality*; D016009:Chi-Square Distribution; D003326:Coronary Circulation; D003920:Diabetes Mellitus / Q000401:mortality*; D004739:England / Q000453:epidemiology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016016:Proportional Hazards Models; D012042:Registries; D012044:Regression Analysis; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome