Outcomes in diabetic patients undergoing primary percutaneous coronary intervention for acute anterior myocardial infarction: Results from the INFUSE-AMI study

Authors

  • Elias A. Sanidas MD, PhD,

    1. Cardiovascular Research Foundation, New York, New York
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  • Sorin J. Brener MD,

    Corresponding author
    1. Cardiovascular Research Foundation, New York, New York
    2. Department of Medicine/Cardiology, New York Methodist Hospital, Brooklyn, New York
    • Correspondence to: Sorin J. Brener, MD, Professor of Medicine, Director, Cardiac Catheterization Laboratory, NY Methodist Hospital, Brooklyn, NY. E-mail: sjb9005@nyp.org

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  • Akiko Maehara MD,

    1. Cardiovascular Research Foundation, New York, New York
    2. Department of Medicine/Cardiology, Columbia University Medical Center and New York Presbyterian Hospital, New York, New York
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  • Philippe Généreux MD,

    1. Cardiovascular Research Foundation, New York, New York
    2. Department of Medicine/Cardiology, Hôpital du Sacré-Coeur de Montréal, Université de Montréal, Montréal, Québec, Canada
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  • Bernhard Witzenbichler MD,

    1. Department of Medicine/Cardiology, Charité Campus Benjamin Franklin, Berlin, Germany
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  • Magdi El-Omar MD,

    1. Department of Medicine/Cardiology, Manchester Heart Center, Manchester, United Kingdom
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  • Martin Fahy MSC,

    1. Cardiovascular Research Foundation, New York, New York
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  • Roxana Mehran MD,

    1. Cardiovascular Research Foundation, New York, New York
    2. Department of Medicine/Cardiology, Mount Sinai Medical Center, New York, New York
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  • C. Michael Gibson MD,

    1. Department of Medicine/Cardiology, Beth Israel Deaconess Medical Center—Harvard Medical School, Boston, Massachusetts
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  • Gregg W. Stone MD

    1. Cardiovascular Research Foundation, New York, New York
    2. Department of Medicine/Cardiology, Columbia University Medical Center and New York Presbyterian Hospital, New York, New York
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  • Conflict of interest: No authors have relevant conflicts of interest to declare with the exceptions of Dr. Roxana Mehran who reports serving as consultant for Cardiva, Cordis, The Medicines Company, Regado Biosciences, and receiving research grant support from Bristol-Myers Squibb/Sanofi-Aventis, Dr. C. Michael Gibson who received research grant support from Atrium Medical, and Dr. Gregg W. Stone who reports serving on the advisory boards for and receiving honoraria from Boston Scientific and Abbott Vascular.

Abstract

Objectives

To evaluate the clinical, angiographic, and cardiac magnetic resonance imaging (cMRI) results in patients with and without diabetes mellitus (DM) undergoing primary percutaneous coronary intervention (PCI) for ST-elevation myocardial infarction (STEMI).

Background

DM has been associated with increased mortality in patients with STEMI, yet the mechanisms underpinning this association have not been completely elucidated.

Methods

Overall, 451 patients (51 diabetics) from the INFUSE-AMI trial were studied. They presented with an anterior STEMI due to an occluded left anterior descending artery (LAD) and underwent bivalirudin-supported primary PCI with or without intralesion abciximab and with or without thrombus aspiration. Angiographic baseline and post-procedure parameters, cMRI at 30 days, and clinical follow-up at 30 days and at 1 year were compared between diabetic and nondiabetic patients.

Results

Patients with DM had significantly more comorbidities and more extensive LAD disease than nondiabetics. Primary PCI was equally effective in restoring coronary flow in both groups and the infarct size at 30 days was similar (14.3% [7.1, 24.5] vs. 17.3% [8.1, 23.6], respectively, P = 0.55). Diabetic patients had more major cardiovascular and cerebrovascular events at 1 year (16.5% vs. 8.0%, P = 0.04). Stent thrombosis within 30 days after primary PCI was higher in diabetic than in nondiabetic subjects (4.3% vs. 0.8%, P = 0.03).

Conclusions

Patients with DM presenting with STEMI had a higher baseline risk profile than those without DM. Although reperfusion success and infarct size were similar, diabetic patients experienced more death, reinfarction, stent thrombosis, and revascularization than nondiabetics. © 2013 Wiley Periodicals, Inc.

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