J 2020

The Effect of Diabetes on Prognosis Following Myocardial Infarction Treated with Primary Angioplasty and Potent Antiplatelet Therapy

SIMEK, Stanislav, Zuzana MOŤOVSKÁ, Ota HLINOMAZ, Petr KALA, Milan HROMADKA et. al.

Basic information

Original name

The Effect of Diabetes on Prognosis Following Myocardial Infarction Treated with Primary Angioplasty and Potent Antiplatelet Therapy

Authors

SIMEK, Stanislav (203 Czech Republic), Zuzana MOŤOVSKÁ (703 Slovakia, guarantor), Ota HLINOMAZ (203 Czech Republic, belonging to the institution), Petr KALA (203 Czech Republic, belonging to the institution), Milan HROMADKA (203 Czech Republic), Jiri KNOT (203 Czech Republic), Ivo VARVAROVSKY (203 Czech Republic), Jaroslav DUSEK (203 Czech Republic), Richard ROKYTA (203 Czech Republic), Frantisek TOUSEK (203 Czech Republic), Michal SVOBODA (203 Czech Republic, belonging to the institution), Alexandra VODZINSKA (203 Czech Republic), Jan MROZEK (203 Czech Republic) and Jiří JARKOVSKÝ (203 Czech Republic)

Edition

Journal of Clinical Medicine, BASEL, MDPI, 2020, 2077-0383

Other information

Language

English

Type of outcome

Článek v odborném periodiku

Field of Study

30218 General and internal medicine

Country of publisher

Switzerland

Confidentiality degree

není předmětem státního či obchodního tajemství

References:

Impact factor

Impact factor: 4.241

RIV identification code

RIV/00216224:14110/20:00116476

Organization unit

Faculty of Medicine

DOI

UT WoS

000567080400001

Keywords in English

acute myocardial infarction; primary percutaneous coronary intervention; diabetes mellitus; prognosis; antiplatelets; prasugrel; ticagrelor; clopidogrel

Tags

Tags

International impact, Reviewed
Změněno: 21/9/2023 10:58, Mgr. Michal Petr

Abstract

V originále

Purpose: To investigate the prognostic significance of diabetes mellitus (DM) in patients with high risk acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (pPCI) in the era of potent antithrombotics. Methods: Data from 1230 ST-segment elevation myocardial infarction (STEMI) patients enrolled in the PRAGUE-18 (prasugrel vs. ticagrelor in pPCI) study were analyzed. Ischemic and bleeding event rates were calculated for patients with and without diabetes. The independent impact of diabetes on outcomes was evaluated after adjustment for outcome predictors. Results: The prevalence of DMwas 20% (N = 250). Diabetics were older and more often female. They were more likely to have hypertension, hyperlipoproteinemia, multivessel coronary disease and left main disease, and be obese. The primary net-clinical endpoint (EP) containing death, spontaneous nonfatal MI, stroke, severe bleeding, and revascularization at day 7 occurred in 6.1% of patients with, and in 3.5% of patients without DM (HR 1.8; 95% CI 0.978-3.315; p = 0.055). At one year, the key secondary endpoint defined as cardiovascular death, spontaneous MI, or stroke occurred in 8.8% with, and 5.5% withoutDM(HR 1.621; 95% CI 0.987-2.661; p = 0.054). In those with DM the risk of total one-year mortality (6.8% vs. 3.9% (HR 1.773; 95% CI 1.001-3.141; p = 0.047)) and the risk of nonfatal reinfarction (4.8% vs. 2.2% (HR 2.177; 95% CI 1.077-4.398; p = 0.026)) were significantly higher compared to in those without DM. There was no risk of major bleeding associated with DM (HR 0.861; 95% CI 0.554-1.339; p = 0.506). In the multivariate analysis, diabetes was independently associated with the one-year risk of reinfarction (HR 2.176; 95% Confidence Interval, 1.055-4.489; p = 0.035). Conclusion: Despite best practices STEMI treatment, diabetes is still associated with significantly worse prognoses, which highlights the importance of further improvements in the management of this high-risk population.