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Benefit of angiographic spontaneous reperfusion in STEMI: does it extend to diabetic patients?
K R Bainey1, Y Fu, C B Granger
1University of Alberta, Edmonton, Alberta, Canada.
Insights
Spontaneous reperfusion (SR) is less frequent in ST-elevation myocardial infarction (STEMI) patients with diabetes. However, diabetic patients with normal blood glucose and SR show improved outcomes after primary percutaneous coronary intervention (PCI).
Area of Science:
- Cardiology
- Diabetology
- Interventional Cardiology
Background:
- Spontaneous reperfusion (SR) in ST-elevation myocardial infarction (STEMI) is linked to better clinical outcomes.
- The incidence and impact of SR in diabetic STEMI patients undergoing primary percutaneous coronary intervention (PCI) remain unclear.
Purpose of the Study:
- To systematically analyze SR in diabetic patients within a large STEMI cohort treated with primary PCI.
- To investigate the relationship between SR, baseline blood glucose levels, and clinical outcomes in diabetic and non-diabetic STEMI patients.
Main Methods:
- Evaluation of 4944 patients from the APEX AMI study, with 15.5% identified as diabetic.
- SR defined as pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow.
- Analysis of post-PCI TIMI 3 flow and 90-day composite outcomes (death/shock/congestive heart failure) stratified by diabetic status, SR, and baseline blood glucose levels.
Main Results:
- SR occurred in 11.5% of patients, being less common in diabetic (9.2%) versus non-diabetic patients (11.9%).
- Patients with SR demonstrated improved post-PCI TIMI 3 flow regardless of diabetic status.
- While SR significantly improved outcomes in non-diabetic patients, this benefit was not significant in the overall diabetic cohort. However, diabetic patients with normoglycemia and SR showed improved 90-day outcomes.
Conclusions:
- SR is less frequent in diabetic STEMI patients.
- Diabetic patients without SR exhibit poorer post-PCI epicardial patency, contributing to adverse outcomes.
- Normal baseline blood glucose combined with SR in diabetic patients is associated with enhanced epicardial flow post-PCI and a better prognosis.
Background:
Spontaneous reperfusion (SR) in ST elevation myocardial infarction (STEMI) improves clinical outcome, yet its incidence and impact among diabetic patients is unclear.
Objective:
To carry out a systematic analysis of SR in the diabetic cohort of a large primary percutaneous coronary intervention (PCI)-treated population with STEMI.
Methods And Results:
4944 patients (15.5% diabetic) undergoing primary PCI in the APEX AMI study were evaluated. SR defined as pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow occurred in 11.5% of patients; it was more common in non-diabetic (11.9%) than in diabetic patients (9.2%) (p = 0.028). Patients with SR versus no SR had improved post-PCI TIMI 3 flow: in non-diabetic patients (99.8% vs 90.3%, p<0.001) and in diabetic patients (98.6% vs 84.9%, p<0.001). Non-diabetic patients with SR showed a significant improvement in 90-day death/shock/congestive heart failure (CHF) compared with those without SR: 4.4% versus 8.9% (p = 0.001), respectively. The composite outcome in diabetic patients with versus without SR was 10.0% versus 14.9% (p = 0.270), respectively. When outcomes were examined according to tertiles of baseline blood glucose, both non-diabetic and diabetic patients with normoglycaemia showed higher SR rates (15.5%, 10.3%, 7.3% for non-diabetic patients, p<0.001; 17.4%, 7.2%, 9.1% for diabetic patients, p = 0.132), greater ST resolution (55.4%, 52.6%, 49.7% for non-diabetic patients, p = 0.030; 50%, 46.4%, 39.1% for diabetic patients, p = 0.179), and improved 90-day death/shock/CHF (5.2%, 8.3%, 14% for non-diabetic patients p<0.001; 8.7%, 4.2%, 15.8% for diabetic patients, p = 0.006).
Conclusions:
These data indicate that SR is less common in diabetic patients with STEMI. Diabetic patients without SR have worse post-PCI epicardial patency, which contributes to adverse outcomes. Diabetic patients with normal baseline blood glucose and SR have enhanced epicardial flow after PCI and improved prognosis.
