Primary stenting in acute myocardial infarction: Influence of diabetes mellitus in angiographic results and clinical outcome

Background The outcome of patients with diabetes after myocardial infarctio n (MI) has traditionally been worse than in their nondiabetic counterparts before and during the thrombolytic therapy era. Whether the fate of patient s with diabetes might improve with mechanical intervention, particularly wi th primary stenting, has not previously been studied. Methods We compared the angiographic and clinical outcome of 76 nondiabetic patients (aged 61 +/- 14 years; 66% male) and 28 patients with diabetes (a ged 65 +/- 12 years; 64% male) consecutively treated with primary stenting for acute MI. Coronary Thrombolysis In Myocardial Infarction grade 3 flow w as restored in 96% of diabetic and 97% of nondiabetic patients. Results Angiographic results after stent deployment were similar in the 2 g roups. At 1-month follow-vp, all patients in both groups were alive. Patien ts with diabetes had a much higher incidence of stent thrombosis (18% vs 1% ; P =.003), which accounted for the majority of the major cardiac events at 1 month (21% vs 4%; P =.009). At a mean follow-vp of 315 +/- 13 days, 99% of nondiabetic and 89% of patients with diabetes were alive (P =.04). Overa ll Freedom from a major cardiac event (death, MI, target vessel revasculari zation) at 315 +/- 13 day Follow-vp was 88% For nondiabetics and 54% for pa tients with diabetes (P =.0003). By multivariate analysis, diabetes mellitu s was the most important predictor for development of 1-month (RR 9.89; 95% confidence interval, 1.6-30) and late major cardiovascular events (RR 8.39 ; 95% confidence interval, 2.93-24). Conclusions Primary stenting in acute MI is highly effective in restoring i mmediate TIMI 3 coronary flow in nondiabetic patients and patients with dia betes, This procedure may improve benefit in terms of mortality rate to bot h groups, particularly in patients with diabetes, compared with previews re ports with thrombolytic therapy. Nevertheless, stent thrombosis and major c ardiovascular events at 1 month and late follow-up are more frequent in pat ients with diabetes.