In the Journals

Diabetes increased risk for poor outcomes after PCI for STEMI

Diabetes was associated with a nearly fourfold increase in mortality compared with patients without diabetes in a cohort of patients who underwent PCI for STEMI in the INFUSE-AMI trial.

In the substudy, investigators compared 51 patients with diabetes and 400 patients without diabetes from INFUSE-AMI for clinical, angiographic and cardiac MRI results after procedure.

Eligible participants presented with an anterior STEMI resulting from an occluded left anterior descending artery (LAD). Treatment included bivalirudin-supported (Angiomax, The Medicines Company) primary PCI with or without intralesional abciximab (ReoPro, Centocor) and with or without thrombus aspiration.

Investigators evaluated the diabetes and nondiabetes cohorts for angiographic characteristics at baseline and post-procedure parameters. Assessments were made after clinical MRI at 30 days and clinical follow-up at 30 days and 1 year.

Diabetes was associated with significantly more comorbidities and extensive LAD disease than nondiabetes. Thirty-day results indicated a rate of cardiac death of 8.1% in the diabetes cohort and 2.3% in the nondiabetes cohort (P=.02). There were more Q-wave MIs in the diabetes group at 30 days (2.2% vs. 0%; P=.004) and at 1 year (12.4% vs. 3.8%; P=.008).

The revascularization rate at 30 days was 6.4% in the diabetes group and 1% in the nondiabetes group (P=.006). At 1 year, the revascularization rates were increased in the diabetes group (11.1% vs. 4.1%; P=.03).

Patients in the diabetes group also were more likely to experience definite or probable stent thrombosis within 30 days of implantation (4.3% vs. 0.8%; P=.03).

Primary PCI demonstrated efficacy in restoring coronary flow in both the diabetes and nondiabetes groups. At 30 days, infarct sizes were 14.3% in the diabetes group and 17.3% in the nondiabetes group (P=.55).

One-year CV and cerebrovascular rates were 16.5% for diabetes and 8% for nondiabetes (P=.04).

The researchers concluded that diabetes was associated with a higher baseline risk profile than nondiabetes in the STEMI setting. Despite successful reperfusion and similar infarct sizes, outcomes were worse in the diabetes group.