Background: Spontaneous reperfusion (SR) in ST elevation myocardial infarction (STEMI) improves clinical outcome, yet its incidence and impact amongst diabetics is unclear. Accordingly, we undertook a systematic analysis of SR in the diabetic cohort of a large primary percutaneous coronary intervention (PCI) treated STEMI population.
Methods and results: 4,944 patients (15.5% diabetic) undergoing primary PCI in the APEX AMI study were evaluated. SR defined as pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow occurred in 11.5% of patients; it was more common in non-diabetics (11.9%) compared to diabetics (9.2%) (p=0.028). Patients with SR versus no SR had improved post PCI TIMI 3 flow: in non-diabetics (99.8 % vs. 90.3%, p<0.001) and diabetics (98.6% vs. 84.9%, p<0.001). Non-diabetics with SR showed significant improvement in 90-day death/shock/congestive heart failure versus without SR; 4.0% versus 8.9% (p=0.001) respectively. The composite outcome in diabetics with SR versus without SR was 10.0% versus 14.9% (p=0.270) respectively. When outcomes were examined according to tertiles of baseline blood glucose, both non-diabetics and diabetics with normoglycemia showed higher SR rates (15.5%, 10.3%, 7.3% for non-diabetics, p<0.001; 17.4%, 7.2%, 9.1% for diabetics, p=0.132), greater ST-resolution (55.4%, 52.6%, 49.7% for non-diabetics, p=0.030; 50%, 46.4%, 39.1% for diabetics, p=0.179), and improved 90-day death/shock/congestive heart failure (5.2%, 8.3%, 14% for non-diabetics p<0.001; 8.7%, 4.2%, 15.8% for diabetics, p=0.006).
Conclusions: These data indicate that SR is less common in diabetics with STEMI. Diabetics without SR have worse post PCI epicardial patency which contributes to adverse outcomes. Diabetics with normal baseline blood glucose and SR have enhanced epicardial flow post PCI and improved prognosis.
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