Influence of diabetes mellitus on outcome in the era of primary stenting for acute myocardial infarction

The purpose of the present study was to examine the influence of diabetes mellitus (DM) on the clinical and angiographic outcomes in 62 diabetic and 152 nondiabetic patients with acute myocardial infarction (AMI) treated with primary coronary stenting within 12 h of the onset of symptoms. The diabetic patients had a greater incidence of hyperlipidemia, prior myocardial infarction (MI) and multivessel disease. There were no statistically significant differences in other variables. Procedural success was similar in the 2 groups. At a mean followup of 2.1 +/- 0.6 years, 13% of diabetic and 11% of nondiabetic patients had died (p=0.70). The percentage of target vessel revascularization (TVR) was 37% of diabetic and 20% of nondiabetic patients (p=0.003). Rates of major adverse cardiac events (MACE: death, non-fatal MI, TVR) were 50% of diabetic and 32% of nondiabetic patients (p=0.007). On multivariate analysis, DM was not a predictor of death. Independent predictors of death were age, multivessel disease, TIMI less than or equal to2 and cardiogenic shock. However, DM and age were independent predictors of MACE. In conclusion, DM is not an independent predictor of death in patients with AMI after stenting, but diabetic patients had a higher incidence of TVR, making DM an independent predictor of MACE.