Impact of Diabetes on Long-Term Outcome After Primary Angioplasty

Abstract

OBJECTIVEDiabetes has been shown to be associated with worse survival and repeat target vessel revascularization (TVR) after primary angioplasty. The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents (BMS) and drug-eluting stents (DES).RESEARCH DESIGN AND METHODSOur population is represented by 6,298 ST-segment elevation myocardial infarction (STEMI) patients undergoing primary angioplasty included in the DESERT database from 11 randomized trials comparing DES with BMS.RESULTSDiabetes was observed in 972 patients (15.4%) who were older (P < 0.001), more likely to be female (P < 0.001), with higher prevalence of hypertension (P < 0.001), hypercholesterolemia (P < 0.001), and longer ischemia time (P < 0.001), and without any difference in angiographic and procedural characteristics. At long-term follow-up (1,201 ± 441 days), diabetes was associated with higher rates of death (19.1% vs. 7.4%; P < 0.0001), reinfarction (10.4% vs. 7.5%; P < 0.001), stent thrombosis (7.6% vs. 4.8%; P = 0.002) with similar temporal distribution—acute, subacute, late, and very late—between diabetic and control patients, and TVR (18.6% vs. 15.1%; P = 0.006). These results were confirmed in patients receiving BMS or DES, except for TVR, there being no difference observed between diabetic and nondiabetic patients treated with DES. The impact of diabetes on outcome was confirmed after correction for baseline confounding factors (mortality, P < 0.001; repeat myocardial infarction, P = 0.006; stent thrombosis, P = 0.007; TVR, P = 0.027).CONCLUSIONSThis study shows that among STEMI patients undergoing primary angioplasty, diabetes is associated with worse long-term mortality, reinfarction, and stent thrombosis in patients receiving DES and BMS. DES implantation, however, does mitigate the known deleterious effect of diabetes on TVR after BMS.

Selective use of contemporary drug-eluting stents in primary angioplasty for ST-elevation myocardial infarction: pooled analysis of COMFORTABLE AMI and EXAMINATION

“…Selective use of DES has become common practice, particularly in healthcare systems with limited resources. Often, additional patient factors such as the presence of diabetes and the mode of presentation are taken into account when choosing between DES and BMS [14][15][16] .…”

O doente diabético com doença coronária crónica. Como revascularizar?

“…O aparecimento das próteses endo-coronárias diluidoras de fármacos e em particular as gerações mais recentes, representa o maior avanço neste domínio. as propriedades dos novos dispositivos permitiram resolver de forma clara o grande problema da re-estenose, vantagem que se estendeu também aos doentes diabéticos 10 incluindo igualmente os doentes tratados no contexto do enfarte agudo do miocárdio, nos quais a carga trombótica é mais marcada 11 . uma meta-análise de 42 estudos clínicos 12 , envolvendo 22 844 doentes, confirma a superioridade dos novos dispositivos quando comparados com as gerações iniciais.…”

IS THERE ANY POINT INCARDIOMETABOLIC THERAPY IN THE TREATMENT OF PATIENTS WITH CORONARY ARTERY DISEASE AND TYPE 2 DIABETES MELLITUS? (literature review)

“…Как правило, эти два процесса развиваются параллельно. Основной причиной ДКМП является на-рушение окислительно-восстановительных реакций вследствие недостаточного поступ-ления энергетических субстратов в усло-виях гипергликемии [5][6][7][8]. Таким образом, ДКМП патогенетически представляет собой один из вариантов дисметаболической кар-диопатии и подразумевает специфические для диабета дистрофические изменения в миокарде за счет длительных метаболи-ческих нарушений в виде присущих диабе-ту нарушений: энергообеспечения клеток, синтеза белков, электролитного обмена и обмена микроэлементов, окислительно-восстановительных процессов, кислородно-транспортной функции крови и др.…”

“…Поражение сосудов у больных СД.Для пациентов с СД 2 типа характерно ускорен-ное развитие и прогрессирование атероскле-ротического процесса [5,7,8].…”

“…В многочис-ленных исследованиях было продемонстри-ровано, что у пациентов с метаболическим синдромом, у лиц с СД 2 типа, имело ме-сто достоверно более частое развитие дан-ного феномена. Достоверно чаще у паци-ентов с СД 2 типа развивался дистальный эмболизм, который ассоциировался с более низкой выживаемостью при длительном на-блюдении [5,8,28,29].…”