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Higher one-year mortality in patients with diabetes and ST-segment elevation myocardial infarction undergoing primary percutaneous coronary intervention
Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Danderyd University Hospital, Stockholm, Sweden.
Department of Clinical Sciences, Karolinska Institutet, Stockholm, Sweden; Department of Internal Medicine, Danderyd University Hospital, Stockholm, Sweden.
Örebro University, School of Medical Sciences. Department of Cardiology.
Department of Medical Sciences, Cardiology and Uppsala Clinical Research center, Uppsala University, Uppsala, Sweden.
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2017 (English)In: Diabetologia, ISSN 0012-186X, E-ISSN 1432-0428, Vol. 60, no Suppl. 1, S529-S530 p.Article in journal, Meeting abstract (Other academic) Published
Abstract [en]

Background and aims: Patients with diabetes mellitus have a worse prognosis after acute coronary syndromes than patients without diabetes. Outcomes in patients with diabetes after ST-segment elevation myocar-dial infarction (STEMI) in the era of modern interventional treatment and antiplatelet therapy are less well studied. The aim is to characterise outcomes and complications in a contemporary population with diabetes and STEMI undergoing primary percutaneous coronary intervention (PCI).

Materials and methods: In the registry-based randomised Thrombus Aspiration in ST-Elevation myocardial infarction in Scandinavia (TASTE) trial, 7244 patients with STEMI were randomised to undergo manual thrombus aspiration followed by PCI or to undergo PCI alone. Thrombus aspiration did not affect mortality at one year in the 1005 patients (13.9%) with diabetes [Hazard ratio (HR) 1.04; CI 0.69-1.58,p=0.839]. Therefore, all patients with diabetes, irrespective ofrandomisation in TASTE, were studied as one cohort. All patients were followed for incidence of all-cause mortality, myocardial infarction or stent thrombosis until one year after index event. HRs were calculated using a Cox proportional hazard regression model adjusted for comorbidities.

Results: Patients with diabetes were older (mean age 67.6 vs 66.0 years, p<0.001), more often had a previous myocardial infarction (19.9 vs 10.3%, p<0.001) and undergone previous PCI (17.3 vs 8.4%, p<0.001). Thrombus grade did not differ between patients with and without diabetes (Grade 0 to Grade 5, p=0.909) and neither did the type of affected coronary vessel. Pharmacological cardiovascular treatment did not differ between groups, but the use of drug eluting stents was higher in patients with diabetes (59.0 vs 48.4%, p<0.001). After adjustment for comorbidities, diabetes independently increased the risk for mortality (HR 1.57; CI 1.23-2.00, p<0.001), but was not an independent risk factor for future myocardial infarction or stent thrombosis.

Conclusion: Diabetes remained an adverse prognostic risk factor in this contemporary setting, resulting in increased one-year mortality in a large cohort of patients with STEMI treated with PCI. This was not influenced by thrombus aspiration and not explained by a higher thrombus burden or differences in cardiovascular medical therapy compared to patients without diabetes.

Place, publisher, year, edition, pages
Springer, 2017. Vol. 60, no Suppl. 1, S529-S530 p.
National Category
Endocrinology and Diabetes
Identifiers
URN: urn:nbn:se:oru:diva-61640DOI: 10.1007/s00125-017-4350-zISI: 000408315003266OAI: oai:DiVA.org:oru-61640DiVA: diva2:1150193
Conference
53rd Annual Meeting of the European-Association-for-the-Study-of-Diabetes (EASD), Lisbon, Portugal, September 11-15, 2017
Available from: 2017-10-18 Created: 2017-10-18 Last updated: 2017-10-18Bibliographically approved

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