Turk Kardiyol Dern Ars. 2002; 30(9): 534-543
Primary Coronary Stent Implantation for Acute Myocardial Infarction in Diabetic versus Nondiabetic Patients: In-hospital and Clinical Follow-up Results
, Hüseyin YILMAZ1
, İbrahim BAŞARICI1
, Oktay SANCAKTAR1
, Necmi DEĞER1
Diabetic patients had poorer clinical outcomes during acute myocardial infarction (AMI) compared to nondiabetic patients in the prethrombolysis era. Less is known about the impact of diabetes on early and late clinical outcomes in patients undergoing coronary stent implantation during AMI. This study compares the in-hospital and long term clinical outcomes of AMI patients with and without diabetes. Seven-hundred seventy-four patients who underwent primary coronary stent implantation for AMI in our clinic between 1997 and 2001 were included in the study. We compared the angiographic and clinical outcomes of nondiabetic (aged 55.9 ± 10.6 years; 82.6% male) and diabetic (aged 56.8 ± 11.7 years; 63.1% male) patients treated by primary stenting for acute MI. The in-hospital results and follow-up clinical outcomes of each group were retrospectively analyzed.
RESULTS The nondiabetic group consisted of 633 (81.8%) patients and the diabetic group of 141 patients. Diabetic patients had a higher incidence of hypertension, hyperlipidemia, and unstable hemodynamic status compared to nondiabetic patients (p=0.001, 0.003, 0.001 respectively). Smoking and male gender rates were significantly higher in nondiabetic patients (p= 0.001, and 0.001, respectively). Angiographic success rates and prominent clinical improvement rates were 96.4% and 90.7% vs 96.7% and 95.1% in diabetic and nondiabetic patients, respectively (p=NS, 0.04, respectively). Diabetic patients had a higher incidence of in-hospital deaths and overall events (p=0.028). At 1-month follow-up, diabetic patients had required more target vessel revascularization (5.6% vs. 1.6%; P = 0.006), which accounted for the majority of the major cardiac events at 1 month (20.6% vs. 7.4%; P = 0.003). At a mean follow-up of 7.2 ± 2.7 months, 92.9% of nondiabetic and 88% of diabetic patients were alive (p = 0.05). Overall survival from a major cardiac event (death, MI, target vessel revascularization) at 7.2 ± 2.7 month follow-up was 75.8% for nondiabetics and 58.1% for diabetic patients (P <001). By multivariate analysis, age, diabetes, shock, hemodynamic instability and female gender were the most important predictors for development of 1-month and late major cardiovascular events.
CONCLUSION Primary stenting in the setting of acute MI is effective in restoring immediate TIMI 3 coronary flow both in diabetic and nondiabetic patients. This procedure may prove tobe of benefit in reducing mortality in both groups, particularly in diabetic patients, where this benefit is more prominent compared to thrombolytic therapy. Nevertheless, major cardiovascular events at 1 month and intermediate term follow-up are more frequent in diabetic patients.
How to cite this article
İbrahim DEMİR, Hüseyin YILMAZ, İbrahim BAŞARICI, Oktay SANCAKTAR, Necmi DEĞER. Primary Coronary Stent Implantation for Acute Myocardial Infarction in Diabetic versus Nondiabetic Patients: In-hospital and Clinical Follow-up Results. Turk Kardiyol Dern Ars. 2002; 30(9): 534-543