- NEWS . 28 Sep 2020
Diabetes impacts worse prognosis in post-MI patients treated with PCI and antithrombotics
In an effort to evaluate the prognostic significance of diabetes mellitus (DM) in patients with high-risk acute myocardial infarction (MI) receiving primary percutaneous coronary intervention (pPCI) and antithrombotic therapy, researchers analysed data from 1,230 ST-segment elevation MI (STEMI) patients enrolled in the PRAGUE-18 (prasugrel vs ticagrelor in pPCI) study.
The prevalence of DM was 20% (n=250). The patients with DM were older, more often female, as well as more likely to have hypertension, hyperlipoproteinemia, multivessel coronary disease and left main disease, and be obese. The primary net-clinical endpoint (i.e. death, spontaneous nonfatal MI, stroke, severe bleeding and revascularization) at day 7 occurred in 6.1% and 3.5% of patients with and without DM, respectively (hazard ratio [HR], 1.8, 95% confidence interval [CI], 0.978–3.315; p=0.055). At 1 year, the key secondary endpoint (i.e. cardiovascular death, spontaneous MI or stroke) occurred in 8.8% of patients with, and in 5.5% of those without DM (HR, 1.621, 95% CI, 0.987–2.661; p=0.054).
Additionally, those with DM had higher risks of total 1-year mortality and nonfatal reinfarction compared with those without DM. No association was found between DM status and risk of major bleeding. In the multivariate analysis, diabetes was independently associated with the 1-year risk of reinfarction (HR, 2.176, 95% CI, 1.055–4.489; p=0.035).
The study findings highlight the need for further improvements in managing this high-risk population, as despite best practices in STEMI treatment, diabetes is still associated with significantly worse prognoses.
Simek S, et al. The effect of diabetes on prognosis following myocardial infarction treated with primary angioplasty and potent antiplatelet therapy. J Clin Med 2020;9:E2555.