A comparison of the outcome in diabetic and non-diabetic patients with prolonged ST-segment elevation myocardial infarction subjected to primary coronary angioplasty on the basis of the Western Pomerania Database for the year 2003

Abstract

Background: Of all patients with acute coronary syndrome with prolonged ST-segment elevation (STEMI) 13-25% suffer from diabetes mellitus. Despite the introduction of fibrinolytic therapy, patients with STEMI and diabetes have worse prognosis than those without diabetes. The introduction of primary angioplasty as the preferred method of treatment in this group of patients has improved the prognosis somewhat. However, the problem has not been totally solved and diabetic patients still show worse prognosis when compared to non-diabetics, especially in long-term follow-up. The aim of our study was to compare short-term and long-term outcomes in diabetic and non-diabetic patients treated with primary angioplasty for STEMI in the Western Pomeranian Region of Poland between January and December 2003.
Methods: The medical files of patients treated for acute coronary syndromes in centres in the Western Pomeranian Region of Poland were analysed. The inclusion criteria were hospitalisation between January 1st and December 31st of 2003 as a result of a first or subsequent STEMI recognised according to European Cardiological Society guidelines. The study enrolled 329 patients including 60 diabetics (18.2%). The data obtained were categorised according to the unified scheme including risk factors, coexisting diseases and a previous history of myocardial infarction. The following parameters were analysed: complications of the acute phase of myocardial infarction, 30-day mortality and one-year mortality.
Results: Significantly higher 30-day mortality was noted in diabetic patients who underwent percutaneous revascularisation. Similar results were seen in one-year mortality, with values almost four times as high as those for the non-diabetic group (p = 0.00023).
Conclusions: An analysis of the medical files of STEMI patients revealed a higher 30-day mortality and a higher one-year mortality in those patients with coexisting diabetes. These results cannot be attributed to delayed reperfusion therapy, TIMI flow in the related artery or adjuvant pharmacological therapy. The data obtained confirm the observation that diabetes is an important factor in a poor prognosis in patients with acute coronary syndrome with prolonged ST-segment elevation.