Diabetes mellitus is associated with distal embolization, impaired myocardial perfusion, and higher mortality in patients with ST-segment elevation myocardial infarction treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors

• Published in: Atherosclerosis 2009-11, Vol.207 (1), p.181-185
• Main Authors: De Luca, Giuseppe, Gibson, C. Michael, Bellandi, Francesco, Noc, Marko, Dudek, Dariusz, Zeymer, Uwe, Arntz, Hans-Richard, Cutlip, Donald, Maioli, Mauro, Zorman, Simona, Mesquita Gabriel, H, Emre, Ayse, Rakowski, Tomasz, Gyongyosi, Mariann, Huber, Kurt, van’t Hof, Arnoud W.J
• Format: Article
• Language: English
• Subjects: Aged; Angioplasty, Balloon, Coronary - adverse effects; Associated diseases and complications; Atherosclerosis (general aspects, experimental research); Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular; Coronary Angiography; Coronary Circulation - drug effects; Diabetes; Diabetes Complications - drug therapy; Diabetes Complications - mortality; Diabetes Complications - physiopathology; Diabetes Complications - therapy; Diabetes. Impaired glucose tolerance; Distal embolization; Electrocardiography; Embolism - etiology; Embolism - mortality; Embolism - prevention & control; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Female; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Myocardial Infarction - complications; Myocardial Infarction - drug therapy; Myocardial Infarction - mortality; Myocardial Infarction - physiopathology; Myocardial Infarction - therapy; Myocardial perfusion; Platelet Aggregation Inhibitors - therapeutic use; Platelet Glycoprotein GPIIb-IIIa Complex - antagonists & inhibitors; Primary angioplasty; Proportional Hazards Models; Randomized Controlled Trials as Topic; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 0021-9150; 1879-1484
• DOI: 10.1016/j.atherosclerosis.2009.03.042

Abstract Background It has been shown that, among patients with ST-segment elevation myocardial infarction (STEMI), diabetes is associated with a significantly higher mortality. The aim of the current study was to investigate the impact of diabetes on myocardial perfusion and mortality among STEMI patients treated with primary angioplasty and glycoprotein IIb-IIIa inhibitors. Methods Our population is represented by a total of 1662 patients undergoing primary angioplasty for STEMI included in 11 randomized trials. Myocardial perfusion was evaluated by angiography ( n = 1324) or postprocedural ECG ( n = 1371). Distal embolization was defined as an abrupt “cutoff” in the main vessel or one of the coronary branches of the infarct-related artery, distal to the angioplasty site (data available in 1181 patients). Results Diabetes was observed in a total of 281 patients (16.9%). Diabetic patients were older, with a larger prevalence of female gender, hypertension, hypercholesterolemia, advanced killip class at presentation and multivessel disease. Diabetes was associated with impaired postprocedural TIMI 3 flow (82% vs 90%, p < 0.001), MBG 2–3 (60.1% vs 74.2%, p < 0.001), complete ST-segment resolution (43.2% vs 60%, p < 0.001) and more distal embolization (16.4% vs 10.1%, p < 0.0001). The association with impaired MBG and distal embolization was confirmed after correction for baseline confounding factors. Diabetes was associated with significantly impaired mortality (12.6% vs 3.9%, HR = 3.0 [1.84–4.89], p < 0.001), that persisted even after correction for baseline confounding factors (HR = 2.6 [1.52–4.45], p = 0.001). Conclusion This study showed that, among patients with STEMI undergoing primary angioplasty on the top of glycoprotein IIb-IIIa inhibitors, diabetes mellitus is independently associated with impaired perfusion and distal embolization, that contribute to explain the higher mortality observed in these patients.