Primary stenting in acute myocardial infarction: Influence of diabetes mellitus in angiographic results and clinical outcome☆,☆☆,★
Section snippets
Patient selection
From January 1995 to September 1997, a total of 120 consecutive patients were seen at our institution with an acute MI and suitable coronary anatomy for primary coronary stenting. Sixteen patients were excluded from this analysis because of either cardiogenic shock (n = 11) or significant left main coronary disease (n = 5). Diabetes mellitus was present in 28 patients of the remaining 104 patients included in this study.
The possible risks and benefits of the coronary angiogram, coronary
Clinical characteristics
The clinical characteristics of the populations are shown in Table I.
Empty Cell Diabetics (n = 28) Nondiabetics (n = 76) P value Age 65 ± 12 61 ± 14 .2 Male 18 (64%) 50 (66%) .88 Risk factors Hypertension 21 (75%) 45 (59%) .13 Tobacco use 15 (54%) 40 (53%) .93 Hypercholesterolemia 13 (46%) 40 (53%) .57 Previous MI 7 (25%) 17 (22%) .77 Duration of symptoms before procedure (hr)* 4.0 (2, 10) 3.0 (2, 7) .20 Killip class 1 21 (75%) 62 (82%) .30 2 6 (21%) 8 (11%) 3 1 (4%) 6 (8%) Peak CPK* 1208 (519, 2414) 1006 (460, 2320)
Discussion
The outcome of patients with diabetes after acute MI has been significantly worse than their nondiabetic counterparts.1, 2, 3 Before the thrombolytic era, an in-hospital mortality rate of up to 28% was reported for patients with diabetes with acute MI.2 With the advent of thrombolytic agents, the mortality rate of patients with diabetes markedly improved, although it was still significantly worse than in nondiabetic patients.4, 5, 6, 15 The GISSI-2 Investigators4 reported a mortality rate of
References (65)
- et al.
Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis
J Am Coll Cardiol
(1992) - et al.
Acute myocardial infarction in diabetic mellitus and significance of congestive heart failure as a prognostic factor
Am J Cardiol
(1988) - et al.
The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. The MILIS Study Group
J Am Coll Cardiol
(1989) - et al.
Influence of diabetes on mortality in acute myocardial infarction: data from the GISSI-2 study
J Am Coll Cardiol
(1993) - et al.
Significance of diabetes mellitus in patients with acute myocardial infarction receiving thrombolytic therapy. Investigators of the International Tissue Plasminogen Activator/Streptokinase Mortality Trial
J Am Coll Cardiol
(1993) - et al.
Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries
J Am Coll Cardiol
(1997) - et al.
Does primary angioplasty improve the prognosis of patients with diabetes and acute myocardial infarction [abstract]?
J Am Coll Cardiol
(1995) - et al.
Potential mechanisms promoting restenosis in diabetic patients
J Am Coll Cardiol
(1996) - et al.
Prospective, multicenter study of the safety and feasibility of primary stenting in acute myocardial infarction: In-hospital and 30-day results of the PAMI Stent Pilot Trial
J Am Coll Cardiol
(1998) - et al.
A clinical trial comparing primary stenting of the infarct-related artery with optimal primary angioplasty for acute myocardial infarction. Results from the Florence Randomized Elective Stenting in Acute Coronary Occlusions (FRESCO) Trial
J Am Coll Cardiol
(1998)
Angiographic findings and outcome in diabetic patients treated with thrombolytic therapy for acute myocardial infarction: The GUSTO-I experience
J Am Coll Cardiol
Subacute stent thrombosis: evolving issues and current concepts
J Am Coll Cardiol
Thrombosis of a flexible coil coronary stent: frequency, predictors and clinical outcome
J Am Coll Cardiol
Coronary angioplasty and intracoronary thrombolysis are of limited efficacy in resolving early intracoronary stent thrombosis
J Am Coll Cardiol
Subacute stent thrombosis and the anticoagulation controversy: changes in drug therapy, operator technique, and the impact of intravascular ultrasound
Am J Cardiol
Prospective evaluation of hemostatic predictors of subacute stent thrombosis after coronary Palmaz-Schatz stenting
J Am Coll Cardiol
Platelet-dependent thrombin generation in patients with diabetes mellitus: effects of glycemic control on coagulability in diabetes
J Am Coll Cardiol
Haemostatic function and cardiovascular death: early results of a prospective study
Lancet
Diabetes mellitus, vascular disease and thrombosis
Clin Haematol
Diabetic cardiomyopathy
Am Heart J
Small-vessel disease, coronary artery vasodilator reserve, and diabetic cardiomyopathy
Chest
Differences of regional coronary flow reserve assessed by adenosine thallium-201 scintigraphy early and six months after successful percutaneous transluminal coronary angioplasty or stent implantation
Am J Cardiol
Restenosis rates in diabetic patients: a comparison of coronary stenting and balloon angioplasty in native coronary vessels
Circulation
Coronary angioplasty in diabetic patients. The National Heart, Lung, and Blood Institute Percutaneous Transluminal Coronary Angioplasty Registry
Circulation
Coronary angioplasty during emergency angioplasty in high-risk myocardial infarction: data from a multicenter registry [abstract]
J Am Coll Cardiol
Stenting in acute myocardial infarction (STAMI): bailout, conditional, and planned stents [abstract]
J Am Coll Cardiol
Prognostic significance of diabetes mellitus in patients with acute myocardial infarction after recanalization
Diabetes Res Clin Pract
Intracoronary ultrasound observations during stent implantation
Circulation
Results of consecutive series of patients receiving only antiplatelet therapy after optimized stent implantation. Comparison of aspirin alone versus combined ticlopidine and aspirin therapy
Circulation
Intracoronary stenting without anticoagulation accomplished with intravascular ultrasound guidance
Circulation
Intracoronary stent implantation without ultrasound guidance and with replacement of conventional anticoagulation by antiplatelet therapy. 30-day clinical outcome of the French Multicenter Registry
Circulation
Subacute thrombotic complications after intracoronary implantation of Palmaz-Schatz stents
Am Heart J
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From the Department of Cardiology, Ochsner Medical Institutions.
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Reprint requests: Stephen R. Ramee, MD, Cardiac Catheterization Laboratory, Department of Cardiology, Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121.E-mail: [email protected]
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