Abstract 18019: Impact Of Diabetes on Survival after Primary Percutaneous Coronary Intervention for Acute Myocardial Infarction
Background: Diabetes mellitus (DM) is associated with increased mortality following fibrinolysis for ST segment elevation myocardial infarction (STEMI). Primary percutaneous coronary intervention (PPCI) confers improved outcomes compared to fibrinolysis in unselected patients and is now the reperfusion strategy of choice. However, the impact of DM on survival in the era of PPCI for STEMI remains unclear.
Methods: We carried out a retrospective analysis of patients undergoing PPCI for STEMI at a large regional PCI centre in the United Kingdom (covering a population of ∼3.2 million) between August 2002 and September 2009. Thirty day and 1-year mortality, demographic factors and procedural characteristics were compared between patients with and without DM.
Results: During the study period 2628 patients underwent PPCI for STEMI at our centre; 313 (11.9%) patients had DM. All cause mortality at 30 days (7.4% vs 3.7%; P=0.0022) and at 1 year (15.8 vs 6.8; P <0.0001) was higher in patients with DM. Patients with DM were older (mean 64.6 vs 62.3 years; P=0.003) and had a higher prevalence of multi-vessel vessel disease (P<0.0001). DM was independently associated with increased mortality after multivariate adjustment for age, previous MI and multi-vessel disease. Drug eluting stents were deployed more frequently in patients with DM (0.58 vs 0.45 per patient; P=0.011). Final TIMI flow grade achieved was lower in patients with DM (mean 2.78 vs 2.86; P=0.029). Fewer patients with DM were admitted direct to the interventional centre and more required inter-hospital transfer (P<0.05). Symptom to balloon time (Median (minutes) [IQR]: 247 [168–406] vs 211 [152–338]; P<0.0001) and door to balloon time (105 [57–165] vs 86 [51–138]; P=0.001) were longer in patients with DM.
Conclusions: Survival is reduced in patients with DM undergoing contemporary reperfusion with PPCI for STEMI. Delayed presentation and longer times to reperfusion may contribute to poorer outcomes.
- © 2010 by American Heart Association, Inc.