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Primary percutaneous coronary interventions in acute myocardial infarction in diabetic versus non-diabetic patients. In-hospital and long-term results.
Kardiol Pol. 2003 Mar; 58(3):182-9.KP

Abstract

BACKGROUND

It has been well established that in the pre-thrombolytic era diabetic patients had poorer clinical outcome after acute myocardial infarction (AMI) compared to non-diabetic patients. Less is known about the impact of diabetes on early and late clinical outcomes in patients with AMI undergoing primary percutaneous coronary interventions (PCI).

AIM

To compare the in-hospital and long-term clinical outcomes of AMI patients with and without diabetes.

METHODS

Seven hundred seventy-four patients who underwent primary PCI for AMI in our institution between 1997 and 2001 were included in the study. We compared the angiographic and clinical outcomes of 633 (81.8%) non-diabetic (aged 55.9+/-10.6 years; 82.6% male) and 141 (18.2%) diabetic (aged 56.8+/-11.7 years; 63.1% male) patients.

RESULTS

Diabetic patients had a higher incidence of hypertension, hyperlipidemia, and unstable hemodynamic status compared to non-diabetic patients (p=0.001, 0.003, 0.001, respectively). Smoking and male gender rates were significantly more frequent in non-diabetic patients (p=0.001, 0.001, respectively). Angiographic success and prominent clinical improvement were achieved in 96.4% and 90.7% of diabetics vs 96.7% and 95.1% of non-diabetics (p=NS and 0.04, respectively). Diabetic patients had a higher incidence of in-hospital deaths and overall events (p=0.028). At one-month follow-up, diabetic patients required more target vessel revascularisation (5.6% vs 1.6%; p=0.006), which accounted for the majority of major cardiac events at one month (20.6% vs 7.4%; p=0.003). At a mean follow-up of 7.2+/-2.7 months, 92.9% of non-diabetic and 88% of diabetic patients were still alive (p=0.05). Overall survival without any major cardiac event (death, new MI or target vessel revascularisation) at 7.2+/-2.7 month follow-up was 75.8% for non-diabetics and 58.1% for diabetic patients (p<0.01). In the multivariate analysis age, diabetes, shock, hemodynamic instability and female gender were the most important predictors for the development of early and late major cardiovascular events.

CONCLUSIONS

Primary PCI in acute MI is effective in restoring TIMI 3 coronary flow both in diabetic and non-diabetic patients. This procedure may reduce mortality in both groups, particularly in diabetic patients in whom this benefit is more prominent compared to thrombolytic therapy. Nevertheless, early and long-term event rates are significantly higher in diabetics than in non-diabetic patients.

Authors+Show Affiliations

Akdeniz Universitesi Tip Fakültesi, Department of Cardiology, Antalya, Turkey.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

14513092

Citation

Demir, Ibrahim, et al. "Primary Percutaneous Coronary Interventions in Acute Myocardial Infarction in Diabetic Versus Non-diabetic Patients. In-hospital and Long-term Results." Kardiologia Polska, vol. 58, no. 3, 2003, pp. 182-9.
Demir I, Yilmaz H, Basarici I, et al. Primary percutaneous coronary interventions in acute myocardial infarction in diabetic versus non-diabetic patients. In-hospital and long-term results. Kardiol Pol. 2003;58(3):182-9.
Demir, I., Yilmaz, H., Basarici, I., Sancaktar, O., & Deger, N. (2003). Primary percutaneous coronary interventions in acute myocardial infarction in diabetic versus non-diabetic patients. In-hospital and long-term results. Kardiologia Polska, 58(3), 182-9.
Demir I, et al. Primary Percutaneous Coronary Interventions in Acute Myocardial Infarction in Diabetic Versus Non-diabetic Patients. In-hospital and Long-term Results. Kardiol Pol. 2003;58(3):182-9. PubMed PMID: 14513092.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary percutaneous coronary interventions in acute myocardial infarction in diabetic versus non-diabetic patients. In-hospital and long-term results. AU - Demir,Ibrahim, AU - Yilmaz,Hüseyin, AU - Basarici,Ibrahim, AU - Sancaktar,Oktay, AU - Deger,Necmi, PY - 2003/9/27/pubmed PY - 2003/12/10/medline PY - 2003/9/27/entrez SP - 182 EP - 9 JF - Kardiologia polska JO - Kardiol Pol VL - 58 IS - 3 N2 - BACKGROUND: It has been well established that in the pre-thrombolytic era diabetic patients had poorer clinical outcome after acute myocardial infarction (AMI) compared to non-diabetic patients. Less is known about the impact of diabetes on early and late clinical outcomes in patients with AMI undergoing primary percutaneous coronary interventions (PCI). AIM: To compare the in-hospital and long-term clinical outcomes of AMI patients with and without diabetes. METHODS: Seven hundred seventy-four patients who underwent primary PCI for AMI in our institution between 1997 and 2001 were included in the study. We compared the angiographic and clinical outcomes of 633 (81.8%) non-diabetic (aged 55.9+/-10.6 years; 82.6% male) and 141 (18.2%) diabetic (aged 56.8+/-11.7 years; 63.1% male) patients. RESULTS: Diabetic patients had a higher incidence of hypertension, hyperlipidemia, and unstable hemodynamic status compared to non-diabetic patients (p=0.001, 0.003, 0.001, respectively). Smoking and male gender rates were significantly more frequent in non-diabetic patients (p=0.001, 0.001, respectively). Angiographic success and prominent clinical improvement were achieved in 96.4% and 90.7% of diabetics vs 96.7% and 95.1% of non-diabetics (p=NS and 0.04, respectively). Diabetic patients had a higher incidence of in-hospital deaths and overall events (p=0.028). At one-month follow-up, diabetic patients required more target vessel revascularisation (5.6% vs 1.6%; p=0.006), which accounted for the majority of major cardiac events at one month (20.6% vs 7.4%; p=0.003). At a mean follow-up of 7.2+/-2.7 months, 92.9% of non-diabetic and 88% of diabetic patients were still alive (p=0.05). Overall survival without any major cardiac event (death, new MI or target vessel revascularisation) at 7.2+/-2.7 month follow-up was 75.8% for non-diabetics and 58.1% for diabetic patients (p<0.01). In the multivariate analysis age, diabetes, shock, hemodynamic instability and female gender were the most important predictors for the development of early and late major cardiovascular events. CONCLUSIONS: Primary PCI in acute MI is effective in restoring TIMI 3 coronary flow both in diabetic and non-diabetic patients. This procedure may reduce mortality in both groups, particularly in diabetic patients in whom this benefit is more prominent compared to thrombolytic therapy. Nevertheless, early and long-term event rates are significantly higher in diabetics than in non-diabetic patients. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/14513092/Primary_percutaneous_coronary_interventions_in_acute_myocardial_infarction_in_diabetic_versus_non_diabetic_patients__In_hospital_and_long_term_results_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -