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Primary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction.
Kardiol Pol 2007; 65(10):1181-6; discussion 1187-9KP

Abstract

BACKGROUND

Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years.

AIM

To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age.

METHODS

In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied.

RESULTS

Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality.

CONCLUSIONS

In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI.

Authors+Show Affiliations

Department of Hemodynamics, National Institute of Cardiology, Warsaw, Poland. cezary.7400177@pharmanet.com.plNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article

Language

eng pol

PubMed ID

17979046

Citation

Sosnowski, Cezary, et al. "Primary Coronary Intervention in Diabetic Octogenarians With Acute ST Elevation Myocardial Infarction." Kardiologia Polska, vol. 65, no. 10, 2007, pp. 1181-6; discussion 1187-9.
Sosnowski C, Janeczko-Sosnowska E, Woźniak J, et al. Primary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction. Kardiol Pol. 2007;65(10):1181-6; discussion 1187-9.
Sosnowski, C., Janeczko-Sosnowska, E., Woźniak, J., Jasiński, B., Dabrowski, R., Sumiński, A., ... Ruzyłło, W. (2007). Primary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction. Kardiologia Polska, 65(10), pp. 1181-6; discussion 1187-9.
Sosnowski C, et al. Primary Coronary Intervention in Diabetic Octogenarians With Acute ST Elevation Myocardial Infarction. Kardiol Pol. 2007;65(10):1181-6; discussion 1187-9. PubMed PMID: 17979046.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Primary coronary intervention in diabetic octogenarians with acute ST elevation myocardial infarction. AU - Sosnowski,Cezary, AU - Janeczko-Sosnowska,Ewa, AU - Woźniak,Jacek, AU - Jasiński,Bogdan, AU - Dabrowski,Rafał, AU - Sumiński,Andrzej, AU - Wiernikowski,Andrzej, AU - Ostrzycki,Adam, AU - Szwed,Hanna, AU - Ruzyłło,Witold, PY - 2007/11/6/pubmed PY - 2008/4/3/medline PY - 2007/11/6/entrez SP - 1181-6; discussion 1187-9 JF - Kardiologia polska JO - Kardiol Pol VL - 65 IS - 10 N2 - BACKGROUND: Diabetic patients with acute coronary syndrome (ACS) have higher mortality risk than non-diabetic patients. No data are available on long-term results of interventional treatment of ACS in diabetic patients aged > or =80 years. AIM: To compare the effects of primary angioplasty (pPCI) on short- and long-term outcome in diabetic patients > or =80 years with ST-elevation myocardial infarction (STEMI) compared to those without diabetes mellitus (DM) of similar age. METHODS: In 63 consecutive patients (22% with diabetes mellitus) aged 80-93 years (mean 83+/-3) with ST elevation ACS (ACS-STE) coronary angiography was performed. Severity of coronary atherosclerosis, effects of pPCI, one-day mortality, in-hospital mortality and one-year mortality were studied. RESULTS: Severity of coronary atherosclerosis measured by angiographic Gensini score and author's own score was similar in diabetic and non-diabetic patients (23.25+/-9.6 vs. 20.6+/-10.2; NS, and 9.1+/-6.0 vs. 8.1+/-5.4; NS, respectively). In 78.6% of diabetic subjects and in 69.4% of those without DM, pPCI was performed. Successful pPCI, defined as TIMI 3 flow and residual infarct related stenosis <20%, was obtained in 92.2% of patients with DM compared to 83.7% of non-diabetics (NS). One-day mortality was 7.1 vs. 6.1% (NS), in-hospital mortality was 7.1 vs. 17.4% (NS). Successful pPCI reduced 30-day mortality threefold (OR=0.31; p <0.05). Contrast-induced nephropathy occurred in 35.7% of diabetic patients compared to 26.5% of those without diabetes (NS) Contrast-induced nephropathy increased risk for in-hospital mortality fivefold (p <0.02). No significant correlation between DM or baseline glucose level and in-hospital mortality was found. During one-year follow-up mortality rate in diabetic patients was 38.5% compared to 7.3% of those without diabetes (p <0.01). One-year mortality predictors were: age (OR=1.27; p=0.0047), metabolic syndrome (OR=4.4; p <0.04), type 2 diabetes (OR=5.25; p <0.02), insulin treatment (OR=5.7; p <0.03), baseline glucose level (OR=1.01; p <0.007), maximum CK-mass level (OR=1.006; p <0.05), noninvasive STEMI management (OR=5.0; p <0.02), and stroke (OR=7.5; p <0.006). Stroke (OR=40.0; p <0.005) and diabetes (OR=6.2; p <0.01) were identified by multivariable analysis as independent risk factors of one-year mortality. CONCLUSIONS: In patients with DM aged > or =80 years with ACS-STE, severity of coronary atherosclerosis and in-hospital prognosis after pPCI seems to be similar to subjects in the same age without DM. Diabetes mellitus is an independent risk factor of one-year mortality after successful pPCI. SN - 0022-9032 UR - https://www.unboundmedicine.com/medline/citation/17979046/Primary_coronary_intervention_in_diabetic_octogenarians_with_acute_ST_elevation_myocardial_infarction_ L2 - https://medlineplus.gov/heartattack.html DB - PRIME DP - Unbound Medicine ER -