<b>Clinical Outcomes and Left Ventricular Function in Diabetic Patients With Acute Myocardial Infarction Treated by Primary Coronary Angioplasty</b>

Abstract

SUMMARYThe objective of the present study was to compare left ventricular (LV) function and clinical outcomes in diabetics versus nondiabetics with acute myocardial infarction (AMI) treated by primary coronary angioplasty.A total of 327 consecutive AMI subjects were reperfused by primary coronary angioplasty within 12 hours from onset. Diabetes mellitus (DM) was present in 104 of the 327 patients. LV function was serially determined by left ventriculograms taken in the acute and chronic phases (6 months after onset). (I) The early ST-segment resolution rate was lower in DM patients compared with non-DM patients (59% versus 83%, P < 0.0001). (II) During a 6-month follow-up, the percentages of target vessel revascularization (TVR), coronary aorta bypass grafting (CABG), and cardiac death were higher in the DM patients compared with the non-DM patients (TVR: 29% versus 19%; P < 0.05, CABG: 10% versus 5% ; P < 0.05, cardiac death: 12% versus 4%; P = 0.01). (III) The differences in left ventricular ejection fraction (LVEF) between two stages (delta-LVEF) were significantly lower in the DM patients than the non-DM patients (1 ± 9% versus 7 ± 10%, P < 0.0001).(IV) Multivariate analysis identified DM as an independent predictor of cardiac death (Odds ratio 5.5, 95% CI, 1.3-23.7, P < 0.05) and as a sole independent predictor of LVEF deterioration (Odds ratio 5.8, 95% CI, 2.8-11.8, P < 0.001).In patients with AMI treated using primary coronary angioplasty, DM is closely related to left-ventricular systolic dysfunction and a poor patient outcome, including mortality. (Int Heart J 2005; 46: 607-618)

A Study to Evaluate Correlation of Blood Sugar Level and Glycosylated Haemoglobin at the Time of Admission with Severity of Acute Coronary Syndrome in Diabetic Patients

“…Out of patients with ST elevation MI, We had 36.2% patients with anterior wall MI, 25.5% were with inferior wall MI, 23.5% with lateral wall MI, 14.8% with antero-lateral wall MI 16 . In our study, 29.6 % were in Killip class II and III and 28.12% were in Killip class I,12.5% were in Killip class IV 9,16 . The mean value of glycosylated hemoglobin was 9.09+1.24 gm% 8 .…”

“…The occurrence was found to be 1.3 times more common in men. Mean age of presentation of acute coronary syndrome for females was 60.2+9.6 years, slightly earlier as of males which was 60.4+8.3 years 8,9 . In our study majority of patients presented had atypical presentation.…”

“…46.8% had at least 1, 40.7% had 2 risk factors and 7.8% had 3 risk factors. 65.6% had dyslipidemia, 59.3% had hypertension, 26.5% were smokers and 15.62% were obese 9 . In our study, 73.4% had ST elevation MI and 26.6% had Non-ST Elevation MI.…”

“…Maximum numbers of patients were in the age group 51 to 70 years 8,9 . The occurrence was found to be 1.3 times more common in men.…”

Ischemia-Reperfusion Injury Leads to Distinct Temporal Cardiac Remodeling in Normal versus Diabetic Mice

“…Patients with both type 1 and type 2 diabetes have a higher risk for encountering sudden death attributed to acute myocardial infarction (MI) and these individuals also exhibit higher mortality rate and risk for developing left ventricular dysfunction after MI [2], [3]. Although the adverse influence of diabetes on left ventricular dysfunction is now a well established phenomenon, the precise temporal nature and mechanisms responsible are still incompletely understood.…”