Angiographic Findings and Outcome in Diabetic Patients Treated With Thrombolytic Therapy for Acute Myocardial Infarction: The GUSTO-I Experience

Woodfield, Scott L.; Lundergan, Conor F.; Reiner, Jonathan; Greenhouse, Samuel W.; Thompson, Mark; Rohrbeck, Steven; Deychak, Yuri A.; Simoons, Maarten L.; Califf, Robert M.; Topol, Eric J.; Ross, Allan M.

doi:10.1016/s0735-1097(96)00397-x

Cited by 250 publications

(182 citation statements)

References 42 publications

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“…Although current treatment of AMI with fibrinolytic agents and aspirin has led to a marked improvement in the prognosis for AMI [18,19], diabetic patients remain a subgroup at high risk of mortality, both in hospital and after discharge, and diabetes still doubles the case fatality rate [5,7,20]. The results of the present study confirm this, as diabetes status in itself accounted for an increase in the risk of 3-year global mortality by a factor of 1.9.…”

Section: Discussionsupporting

confidence: 79%

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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Aims/hypothesis. Diabetes mellitus is associated with increased mortality in subjects with acute myocardial infarction (AMI). We aimed to estimate the risk of mortality in AMI patients with and without diabetes using the urinary albumin : creatinine ratio (ACR).Methods. This is a prospective study of 121 consecutive, non-selected diabetic AMI patients, 121 age-and sex-matched non-diabetic AMI patients and 61 diabetic non-AMI outpatients as control subjects. All data were obtained during the first 7 days of hospitalisation and each AMI patient was followed for a period of exactly 3 years. Baseline ACR RIA measurements were made on the 1st, 3rd and 7th days of admission. Results. Adjusted ACR values were significantly higher in the diabetic AMI patients than in the diabetic control outpatients (p<0.0001), and a significant difference was observed between the weekly ACR slopes for these two groups (p<0.0001). Microalbuminuria was more prevalent in the diabetic AMI patients than in the non-diabetic AMI patients on the 1st day (62% vs 46%, p=0.01) and 3rd day (41% vs 29%, p=0.04). Among the AMI patients with normoalbuminuria (ACR <30 µg/mg), the mortality rate was 11.6% for the patients without diabetes and 33.8% for those with diabetes (p=0.001). The mortality rate was much higher among the AMI patients with microalbuminuria (ACR ≥30 µg/mg) and similar for the diabetic (68.0%) and non-diabetic patients (74.3%). In a multivariable Cox model, ACR (p<0.0001) and diabetes status (p=0.01) were associated with adverse outcome even when several other clinical variables were included in the model. Furthermore, a negative interaction was found between diabetes and ACR (p=0.01). Conclusions/interpretation. Microalbuminuria frequently occurs in diabetic and non-diabetic AMI patients during the first 3 days of admission to hospital and can be used to identify subjects at high risk of mortality.

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Section: Discussionsupporting

confidence: 79%

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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“…This is of major public health importance since patients with type 2 diabetes are at increased risk of developing and dying from cardiovascular disease, which accounts for up to 70% of deaths in this population [2]. The epidemiology and characteristics of coronary artery disease in type 2 diabetes are well described in the literature [3][4][5][6][7]. The focus in reducing cardiovascular deaths in diabetes tends almost exclusively to be on reducing fresh coronary events.…”

Section: Introductionmentioning

confidence: 99%

The epidemiology of left ventricular hypertrophy in type 2 diabetes mellitus

2005

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Aims/hypothesis: Patients with type 2 diabetes mellitus are at greater cardiovascular risk than the general population. Although it is widely acknowledged that diabetes is a risk factor for coronary artery disease, the increased prevalence of potentially lethal left ventricular abnormalities in this population is less well appreciated. Methods: We carried out an echocardiographic study of 500 subjects with type 2 diabetes mellitus to assess the prevalence of left ventricular hypertrophy (LVH) and left ventricular systolic dysfunction (LVSD). We also assessed whether abnormalities in diastolic filling parameters were present. Results: Of the 371 patients in whom left ventricular mass could be successfully assessed, 264 had LVH (71%). Left ventricular systolic dysfunction was much less common, being present in 16/385 patients (4.2%). Long axis contraction was abnormal in 29/429 patients (6.8%). Diastolic filling abnormalities were present in 178/435 (41%) of patients who could be classified using the selected criteria. Conclusions: We conclude that left ventricular abnormalities are common in type 2 diabetic patients. As medical therapy is available for both LVH and LVSD and has been demonstrated to reduce cardiovascular death, these left ventricular abnormalities could be ideal targets for screening, followed by selective therapeutic intervention.

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“…This was probably due to lower efficacy of fibrinolytic agents in diabetic patients who are characterized by increased procoagulation activity and impaired endogenous fibrinolysis. 24,25 In accordance with the new guidelines for treatment of patients with STEMI, primary PTCA is the best strategy of treatment in diabetic patients. The Global Utilization of Streptokinase and tPA for Occluded Arteries study showed that the reinfarction rate at 30 days was lower in diabetic individuals undergoing primary PTCA as compared with fibrinolysis.…”

Section: Resultsmentioning

confidence: 99%

Does Reperfusion in the Treatment of Acute Myocardial Infarction Improve the Prognosis of Acute Myocardial Infarction in Diabetic Patients?

Janion¹,

Polewczyk

Gąsior

et al. 2009

Clinical Cardiology

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Background: Diabetic patients have a 6-fold increased mortality in acute coronary syndromes. Hypothesis: Different therapeutic strategies in diabetics with acute coronary syndromes have an impact on in-hospital and long-term prognosis. Methods: A total of 889 consecutive patients with ST-segment elevation myocardial infarction were included and followed-up for at least 6 months. The study population consisted of 168 (18.9%) diabetic patients and 721 nondiabetics. Results: Invasive therapy and fibrinolysis were less frequently used in diabetic patients (38.7% versus 50.2%; p = 0.0071 and 8.3% versus 15%; p = 0.024, respectively). In-hospital mortality in diabetic individuals was almost twice as high as in nondiabetic subjects (20.2% versus 11.1%; p<0.0014). In-hospital mortality was slightly higher in diabetic patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA; 8.3% versus 4.8%; p = 0.35), but lower in those treated with fibrinolysis (7.7% versus 16%; p = 0.7) compared with the rest of the patients. At 6-mo follow-up mortality was significantly higher in diabetic subjects as compared with nondiabetic subjects (28.0% versus 15.1%; p<0.0001). The highest number of deaths was found in individuals receiving conservative treatment with diabetic subjects significantly outnumbering nondiabetic individuals (40.1% versus 27.9%; p = 0.028 at 6 mo). Both in-hospital and 6-mo mortality were similar in diabetics and nondiabetics receiving reperfusion therapy (7.1% versus 8.2%; p<0.68 and 9.3% versus 15.3%; p<0.098, respectively). Conclusion: Reperfusion therapy, both fibrinolysis and the invasive approach, reduced in-hospital mortality from that observed in nondiabetic individuals.

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Angiographic Findings and Outcome in Diabetic Patients Treated With Thrombolytic Therapy for Acute Myocardial Infarction: The GUSTO-I Experience

Cited by 250 publications

References 42 publications

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

The epidemiology of left ventricular hypertrophy in type 2 diabetes mellitus

Does Reperfusion in the Treatment of Acute Myocardial Infarction Improve the Prognosis of Acute Myocardial Infarction in Diabetic Patients?

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