Emerging concepts in the management of acute myocardial infarction in patients with diabetes mellitus

Although fibrinolysis has improved survival of patients after myocardial in farction (MT), such therapy is less likely to be administered to patients:w ith diabetes. Furthermore, these patients present later (15 min) than nondi abetics. Moreover even with the use of early potent fibrinolytic agents, pa tients with diabetes continued to suffer excessive morbidity and mortality. This finding is not related to the ability-of fibrinolytic agents to resto re complete reperfusion or increased risk of reocclusion of the infarct-rel ated artery. Instead, the impaired ventricular performance at the noninfarc t areas and metabolic derangements during the acute phase of MI may account for the adverse outcome. The efficacy of percutaneous coronary revasculari zation procedures for treatment of acute MI requires further evaluation. Th erapeutic approaches should consider correcting these; abnormalities to aff ord greater survival benefit for this subset of high-risk patients. (C) 200 0 by the American College of Cardiology.