ANGIOGRAPHIC FINDINGS AND OUTCOME IN DIABETIC-PATIENTS TREATED WITH THROMBOLYTIC THERAPY FOR ACUTE MYOCARDIAL-INFARCTION - THE GUSTO-I EXPERIENCE

Objectives. This study sought to determine whether diabetes mellitus, in the setting of thrombolysis for acute myocardial infarction, affect s I) early infarct-related artery patency and reocclusion rates; and 2 ) global and regional ventricular function indexes. We also sought to assess whether angiographic or baseline clinical variables, or both, c an account for the known excess mortality after myocardial infarction in the diabetic population, Background. Mortality after acute myocardi al infarction in patients with diabetes is approximately twice that of nondiabetic patients, It is uncertain whether this difference in mort ality is due to a lower rate of successful thrombolysis, increased reo cclusion after successful thrombolysis, greater ventricular injury or a more adverse angiographic or clinical profile in diabetic patients, Methods. Patency rates and global and regional left ventricular functi on were determined in patients enrolled in the GUSTO-I Angiographic Tr ial, Thirty day mortality differences between those with and without d iabetes were compared, Results, The diabetic cohort had a significantl y higher proportion of female and elderly patients, and they were more often hypertensive, came to the hospital later and had more congestiv e heart failure and a higher number of previous myocardial infarctions and bypass surgery procedures, Ninety-minute patency (Thrombolysis in Myocardial Infarction [TIMI] flow grade 3) rates in patients with and without diabetes were 40.3% and 37.6%, respectively (p = 0.7), Reoccl usion rates were 9.2% vs, 5.3% (p = 0.17). Ejection fraction at 90 min after thrombolysis was similar in diabetic and nondiabetic patients ( [mean +/- SEM] 61.0 +/- 1.6% vs, 60.1 +/- 0.7%, p = 0.7), as was regio nal ventricular function (number of abnormal chords: 19.1 +/- 2.0 vs. 17.5 +/- 0.8, p = 0.3; SD/chord: -2.3 +/- 0.2 vs, -2.4 +/- 0.1, p = 0, 6), Diabetic patients had less compensatory hyperkinesia in the noninf arct zone (SDI chord: 1.3 +/- 0.2 vs, 1.7 +/- 0.1, p less than or equa l to 0.01), No significant difference in ventricular function was note d at 5- to 7-day follow-up, The 30-day mortality rate was 11.3% in dia betic versus 5.9% in nondiabetic patients (p less than or equal to 0.0 001), After adjustment for clinical and angiographic variables, diabet es remained an independent determinant of 30-day mortality (p = 0.02), Conclusions. Early (90-min) infarct-related artery patency as well as regional and global ventricular function do not differ between patien ts with and without diabetes after thrombolytic therapy, except for re duced compensatory hyperkinesia in the noninfarct zone among patients with diabetes. Diabetes remained an independent determinant of 30-day mortality after correction for clinical and angiographic variables. (C ) 1996 by the American College of Cardiology