title: Effects of baseline coronary occlusion and diabetes mellitus in patients with ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention.
abstract: Several studies have highlighted the prognostic role of preprocedural Thrombolysis In Myocardial Infarction (TIMI) flow in the infarct-related artery (IRA) in patients with ST-segment elevation myocardial infarction (STEMI). However, the impact of preprocedural IRA occlusion in patients with diabetes with STEMI has been insufficiently studied. The aim of this study was to evaluate the effects of baseline IRA occlusion and diabetic status in patients with STEMI who underwent primary percutaneous coronary intervention by using data from a pooled analysis of randomized trials comparing intracoronary with intravenous abciximab bolus administration. A total of 3,046 patients with STEMI who underwent primary percutaneous coronary intervention were included. Diabetes was present in 578 patients (19%). The primary outcome was mortality after a median follow-up period of 375 days. Secondary end points were reinfarction and stent thrombosis. In patients without diabetes, IRA occlusion versus no occlusion was not associated with increased rates of mortality (4.3% vs 2.7%, p = 0.051) and reinfarction (3.3% vs 2.5%, p = 0.33). Patients with diabetes with IRA occlusion compared with those without occlusion showed higher rates of mortality (10.6% vs 4.6%, p = 0.01) and reinfarction (5.6% vs 2.1%, p = 0.03). Baseline IRA occlusion increased the rate of stent thrombosis in the nondiabetic (2.1% vs 1.0%, p = 0.04) and diabetic (3.2% vs 0.8%, p = 0.05) cohorts. Interaction analysis demonstrated that the risk for death and reinfarction was significantly increased when diabetes and IRA occlusion occurred concomitantly. In conclusion, patients with STEMI with diabetes and baseline IRA occlusion had disproportionately higher rates of death and reinfarction. Preprocedural IRA occlusion increased the risk for stent thrombosis, irrespective of diabetic status.
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.affiliation: Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark.
authors.forename: Allan Zeeberg
authors.initials: AZ
authors.lastname: Iversen
authors.affiliation: Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Ingo
authors.initials: I
authors.lastname: Eitel
authors.affiliation: Department of Cardiology, Hospital Universitario de Canarias, Tenerife, Spain.
authors.forename: Alberto
authors.initials: A
authors.lastname: Dominguez-Rodriguez
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Youlan L
authors.initials: YL
authors.lastname: Gu
authors.affiliation: Department of Cardiology, Meander Medisch Centrum, Amersfoort, The Netherlands.
authors.forename: Bart J G L
authors.initials: BJ
authors.lastname: de Smet
authors.affiliation: Department of Cardiology, Thorax Center, University Medical Center Groningen, Groningen, The Netherlands.
authors.forename: Karim D
authors.initials: KD
authors.lastname: Mahmoud
authors.affiliation: Department of Physiology, Universidad de La Laguna, Tenerife, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Abreu-Gonzalez
authors.affiliation: Department of Advanced Biomedical Sciences, Federico II University, Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Trimarco
authors.affiliation: Medical Clinic II, University of Lübeck, Lübeck, Germany.
authors.forename: Holger
authors.initials: H
authors.lastname: Thiele
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy. Electronic address: fpiscione@unisa.it.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D000077284:Abciximab; D000368:Aged; D000911:Antibodies, Monoclonal / Q000008:administration & dosage*; D017023:Coronary Angiography; D054059:Coronary Occlusion / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D003331:Coronary Vessels; D003920:Diabetes Mellitus / Q000453:epidemiology*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006801:Humans; D007140:Immunoglobulin Fab Fragments / Q000008:administration & dosage*; D015994:Incidence; D007269:Injections, Intra-Arterial; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology / Q000209:etiology* / Q000601:surgery; D062645:Percutaneous Coronary Intervention; D010975:Platelet Aggregation Inhibitors / Q000008:administration & dosage; D019039:Platelet Glycoprotein GPIIb-IIIa Complex / Q000037:antagonists & inhibitors; D011300:Preoperative Care / Q000379:methods; D011379:Prognosis; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D015912:Thrombolytic Therapy / Q000379:methods*
chemical_list: D000911:Antibodies, Monoclonal; D007140:Immunoglobulin Fab Fragments; D010975:Platelet Aggregation Inhibitors; D019039:Platelet Glycoprotein GPIIb-IIIa Complex; D000077284:Abciximab