title: Long-term clinical outcome of ST-segment elevation myocardial infarction patients with and without diabetes mellitus in the Zwolle trial.
abstract: OBJECTIVE
  We sought to compare long-term survival after ST-segment elevation myocardial infarction (STEMI) in patients with and without diabetes mellitus (DM) treated with primary percutaneous coronary intervention (PCI) or thrombolytic therapy.
  
  
  BACKGROUND
  DM is an adverse prognostic factor after STEMI. However, there is only limited information about long-term clinical outcome in STEMI patients with DM treated with PCI or thrombolysis.
  
  
  METHODS
  Patients with STEMI (n=395) were randomised to treatment either with intravenous streptokinase or PCI. Mean follow-up was 8±2 years. We studied long-term mortality of patients with DM (n=32) and without DM (n=363) and the interaction with the treatment regimen.
  
  
  RESULTS
  After eight years, a total of 17 patients with DM (53%) died compared with 88 (24%) patients without DM (OR 3.5, p<0.001). Reduced left ventricular ejection fraction (LVEF) after STEMI was more often present in patients with DM compared with patients without DM (31% vs. 15%, p=0.01). Multivariate analysis revealed that DM (OR 2.6, 95% CI 1.4-4.7, p=0.002), reduced LVEF (OR 2.4, 95% CI 1.5-3.8, p<0.001) and age ≥60 years (OR 2.4, 95% CI 1.5-3.8, p<0.001) were independent risk factors for long-term mortality. Patients with DM treated with PCI had less LVEF (13% vs. 53%, p=0.01) and lower long-term mortality rates (38% vs. 69%, p=0.08) compared with treatment with thrombolysis.
  
  
  CONCLUSIONS
  STEMI patients with DM are a high-risk group with higher long-term mortality rates compared with patients without DM. PCI is the treatment of choice, particularly in DM patients.
authors.forename: J R
authors.initials: JR
authors.lastname: Timmer
authors.forename: I C C
authors.initials: IC
authors.lastname: van der Horst
authors.forename: J P S
authors.initials: JP
authors.lastname: Henriques
authors.forename: K
authors.initials: K
authors.lastname: Thomas
authors.forename: H J G
authors.initials: HJ
authors.lastname: Bilo
authors.forename: J C A
authors.initials: JC
authors.lastname: Hoorntje
authors.forename: M J
authors.initials: MJ
authors.lastname: de Boer
authors.forename: H
authors.initials: H
authors.lastname: Suryapranata
authors.forename: F
authors.initials: F
authors.lastname: Zijlstra
keywords: acute myocardial infarction; angioplasty; clinical outcome; diabetes mellitus; ventricular function