Abstract 2847: Impact of Primary PCI as Compared to Thrombolysis on Hospital Mortality of STEMI in the High Risk Population of Diabetics in Clinical Practice. Results of the ACOS Registry
Background: Current guidelines for the management of acute ST-elevation myocardial infarction (STEMI) and PCI recommend primary PCI as reperfusion-therapy of first choice as it was shown to be superior to thrombolysis. No data from randomised controlled trials exist for the comparison of primary PCI and thrombolysis in the high risk population of diabetics.
Methods: Between 2000 and 2002 a total of 16816 consecutive patients with acute coronary syndromes were enrolled into the multicenter ACOS-registry in Germany. We examined the impact on the hospital mortality of primary PCI versus thrombolysis in Diabetics with STEMI in clinical practice.
Results: Out of 8303 patients presenting with STEMI, 2202 were diabetics (26.5%), of whom 880 (40%) did not receive any reperfusion therapy, 810 (37%) primary PCI and 512 (23%) thrombolysis. After adjustment for differences in the baseline characteristics, concomitant diseases and the prehospital delay, primary PCI as compared to thrombolysis was associated with a significant lower hospital mortality in the high risk population of diabetics (OR 0.50, CI 0.34–0.73).
Conclusion: In consecutive diabetics with STEMI, reperfusion by primary PCI as compared to thrombolysis was associated with a 50% reduction in hospital mortality in clinical practice. According to current guidelines for the management of STEMI primary PCI is the preferred treatment of reperfusion and should especially be offered to high risk patients as diabetics.