Association of diabetes with increased all-cause mortality following primary percutaneous coronary intervention for ST-segment elevation myocardial infarction in the contemporary era

Abstract

Background:We investigated the association between diabetes mellitus (DM) and all-cause mortality in a large cohort of consecutive patients treated with primary percutaneous coronary intervention (PPCI) in the contemporary era. Methods:We conducted a retrospective analysis of a single-centre registry of patients undergoing PPCI for ST-segment elevation myocardial infarction (STEMI) at a large regional PCI centre between 2005 and 2009. All-cause mortality in relation to patient and procedural characteristics was compared between patients with and without DM. Results: Of 2586 patients undergoing PPCI, 310 (12%) had DM. Patients with DM had a higher prevalence of multi-vessel coronary disease (p<0.001) and prior myocardial infarction (p<0.001). Patients with DM were less commonly admitted directly to the interventional centre (p=0.002). Symptom-to-balloon (p<0.001) and door-to-balloon time (p=0.002) were longer in patients with DM. Final infarct-related-artery TIMI-flow grade was lower in patients with DM (p=0.031). All-cause mortality at 30 days (p=0.0025) and 1 year (p<0.0001) was higher in patients with DM. DM was independently associated with increased mortality after multivariate adjustment for potential confounders. Conclusions: Mortality remains substantially higher in patients with DM following reperfusion for STEMI in comparison with those without diabetes, despite contemporary management with PPCI. Greater co-morbidity, delayed presentation, longer times-to-reperfusion, and less optimal reperfusion may contribute to adverse outcomes.

Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus

“…The findings of the current study are consistent with previous studies showing increased mortality in diabetic patients with CAD following PCI 9, 24, 25. However, our findings are remarkable for revealing differential mortality depending on insulin treatment and PCI settings: increased mortality was only seen in those patients requiring insulin for glycemic management.…”

Prognostic Factors in Patients With Stemi Undergoing Primary PCI in the Clopidogrel Era: Role of Dual Antiplatelet Therapy at Admission and the Smoking Paradox on Long‐Term Outcome

“…In addition, the frailty of the patient undergoing PPCI, mainly represented by co‐morbidities and risk factors present at admission, is an important consideration. Indeed, several prognostic factors are currently known to be associated to a worsening of the clinical outcome in patients with STEMI, including diabetes mellitus, early re‐infarction, Killip class >1, age, renal impairment, and CRP plasma levels …”

Impact of diabetes and hypertension on cardiovascular outcomes in patients with coronary artery disease receiving percutaneous coronary intervention

“…Insulin-treated diabetes mellitus (ITDM) was a strong predictor for long-term mortality when compared with non-DM or non-ITDM patients [5]. After receiving PCI, diabetic patients with ACS had worse short- and mid-term outcomes than non-diabetes patients with ACS [6–9]. For ACS patients with both DM and hypertension, the combination of DM and hypertension appeared to be strongly associated with mortality than in patients with DM or hypertension alone [10].…”