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Clinical outcomes of patients with diabetes mellitus and acute myocardial infarction treated with primary angioplasty or fibrinolysis
  1. L F Hsu,
  2. K H Mak,
  3. K W Lau,
  4. L L Sim,
  5. C Chan,
  6. T H Koh,
  7. S C Chuah,
  8. R Kam,
  9. Z P Ding,
  10. W S Teo,
  11. Y L Lim
  1. Department of Cardiology, National Heart Centre, Singapore
  1. Correspondence to:
    Dr K-H Mak, Department of Cardiology, National Heart Centre, Mistri Wing, 17 Third Hospital Avenue, Singapore 168752;
    MAK_Koon_Hou{at}nhc.com.sg

Abstract

Objective: To compare the early and late outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) with fibrinolytic treatment among diabetic patients with acute myocardial infarction (AMI).

Design: Retrospective observational study with data obtained from prospective registries.

Setting: Tertiary cardiovascular institution with 24 hour acute interventional facilities.

Patients: 202 consecutive diabetic patients with AMI receiving reperfusion treatment within six hours of symptom onset.

Interventions: Fibrinolytic treatment was administered to 99 patients, and 103 patients underwent primary PTCA. Most patients undergoing PTCA received adjunctive stenting (94.2%) and glycoprotein IIb/IIIa inhibition (63.1%).

Main outcome measures: Death, non-fatal reinfarction, and target vessel revascularisation at 30 days and one year were assessed.

Results: Baseline characteristics were similar in these two treatment groups except that the proportion of patients with Killip class III or IV was considerably higher in those treated with PTCA (15.5% v 6.1%, p = 0.03) and time to treatment was significantly longer (103.7 v 68.0 minutes, p < 0.001). Among those treated with PTCA, the rates for in-hospital recurrent ischaemia (5.8% v 17.2%, p = 0.011) and target vessel revascularisation at one year (19.4% v 36.4%, p = 0.007) were lower. Death or reinfarction at one year was also reduced among those treated with PTCA (17.5% v 31.3%, p = 0.02), with an adjusted relative risk of 0.29 (95% confidence interval 0.15 to 0.57) compared with fibrinolysis.

Conclusion: Among diabetic patients with AMI, primary PTCA was associated with reduced early and late adverse events compared with fibrinolytic treatment.

  • angioplasty
  • diabetes
  • fibrinolysis
  • myocardial infarction
  • AMI, acute myocardial infarction
  • CADILLAC, controlled abciximab and device investigation to lower late angioplasty complications
  • EPILOG, evaluation of PTCA to improve long-term outcome by c73E3 glycoprotein IIb/IIIa receptor blockade
  • EPISTENT, evaluation of platelet IIb/IIIa inhibitor for stenting trial
  • GUSTO-IIb, global use of strategies to open occluded coronary arteries in acute coronary syndromes
  • PTCA, percutaneous transluminal coronary angioplasty
  • rt-PA, recombinant tissue-type plasminogen activator
  • TIMI, thrombolysis in myocardial infarction
  • TVR, target vessel revascularisation
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