Primary Percutaneous Coronary Intervention Compared With Fibrinolysis for Myocardial Infarction in Diabetes Mellitus

Abstract

Background: There is growing evidence for a clinical benefit of primary percutaneous coronary intervention (PCI) compared with fibrinolysis; however, whether the treatment effect is consistent among patients with diabetes mellitus is unclear. We compared PCI with fibrinolysis for treatment of ST-segment elevation myocardial infarction in patients with diabetes mellitus.Methods: A pooled analysis of individual patient data from 19 trials comparing primary PCI with fibrinolysis for treatment of ST-segment elevation myocardial infarction was performed. Trials that enrolled at least 50 patients with ST-segment elevation myocardial infarction and randomized patients to receive either primary PCI or fibrinolysis were considered for inclusion in our study. Clinical end points were total deaths, recurrent infarction, death or nonfatal recurrent infarction, and stroke, measured 30 days after randomization.Results: Of 6315 patients, 877 (14%) had diabetes. Thirty-day mortality (9.4% vs 5.9%; PϽ.001) was higher Author Affiliations are listed at the end of this article. Group Information: The members of the Primary Coronary Angioplasty vs Thrombolysis-2 Trialists Collaborators Group are listed at the end of the article.

ESC Guidelines on diabetes, pre-diabetes, and cardiovascular diseases developed in collaboration with the EASD – Summary

“…The benefits of a primary PCI, compared with fibrinolysis were, however, consistent in patients with and without DM. 242 Patients with DM had significantly delayed initiation of reperfusion treatments and longer ischaemic time, but the reduction in 30-day mortality observed in PCItreated patients was most pronounced in this group. Due to a higher absolute risk, the NNT to save one life at 30 days was significantly lower for DM (NNT 17; 95% CI 11-28) than non-DM patients (NNT 48; 95% CI 37-60).…”

Guidelines on myocardial revascularization

“…In STEMI patients, the PCAT-2 [112] collaborative analysis of 19 RCTs showed a similar benefit of primary PCI over fibrinolytic treatment in diabetic and non-diabetic patients. The odds ratio (OR) for mortality with primary PCI was 0.49 for diabetic patients (95% CI 0.31 0.79).…”

Coronary intervention in diabetes: is it different

“…Studies comparing fibrinolytic therapy with primary angioplasty with or without use of GP IIb/IIIa report better short- and long-term outcomes with primary PCI in diabetics. In a recent study of 6315 patients (14% diabetics), 30-day mortality (9.4% vs 5.9%, p=0.001) was higher in patients with diabetes 29. Mortality was lower after primary PCI compared with fibrinolysis in both patients with diabetes (unadjusted OR, 0.49, 95% CI 0.31 to 0.79, p=0.004) and without diabetes (unadjusted OR 0.69, 95% CI 0.54 to 0.86, p=0.001).…”