open access

Vol 1, No 1 (2000): Practical Diabetology
Original articles (translated)
Published online: 2000-09-26
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Type 2 Diabetes and Acute Myocardial Infarction. Angiographic Findings and Results of an Invasive Therapeutic Approach in Type 2 Diabetic Versus Nondiabetic Patients

Bernd Waldecker, Wolfgang Waas, Werner Haberbosch, Reinhard Voss, Mary K. Steen-Müller, Anke Heidessen, Reinhard Bretzel, Harald Tilmanns
Diabetologia Praktyczna 2000;1(1):65-74.

open access

Vol 1, No 1 (2000): Practical Diabetology
Original articles (translated)
Published online: 2000-09-26

Abstract


OBJECTIVE. Mortality in diabetic patients with acute myocardial infarction (MI) is high. The significance of the pretreatment coronary status in type 2 diabetic patients with acute MI, as well as the effect of mechanical revascularization using percutaneous transluminal coronary angioplasty (PTCA), has not been established.
RESEARCH DESIGN AND METHODS. All patients with type 2 diabetes and acute MI (n = 54) were prospectively enrolled into a study of immediate coronary angiography to guide PTCA of the occluded infarct vessel. Hospital and long-term course were assessed and compared with an unselected control group of nondiabetic patients (n = 358) who were enrolled in the same study.
RESULTS. Angiography showed that sites of occlusion and acute coronary flow were similar in both groups. Multivessel disease and shock were more common in type 2 diabetic versus nondiabetic patients: 69 vs. 51% and 21 vs. 10% (P< 0.02), respectively. Direct PTCA was successful in >90% in both groups. Mortality after 30 days was 13% in type 2 diabetic patients versus 5% in patients without diabetes (P< 0.04). Left ventricular (LV) ejection fraction before discharge was lower in diabetic patients (48 ± 17 vs. 55 ± 15%, P< 0.05). Mortality 1 year after discharge was 11 vs. 4% in diabetic versus nondiabetic patients (P< 0.02). Multivariate analysis identified type 2 diabetes as an independent risk factor for acute, but not for late, mortality.
CONCLUSIONS. Direct PTCA is safe and effective in type 2 diabetic patients with acute MI. Mortality after 30 days in unselected diabetic patients is <15% with this approach. Advanced disease and shock contribute to an increased mortality in type 2 diabetic patients with acute MI versus nondiabetic patients.

Abstract


OBJECTIVE. Mortality in diabetic patients with acute myocardial infarction (MI) is high. The significance of the pretreatment coronary status in type 2 diabetic patients with acute MI, as well as the effect of mechanical revascularization using percutaneous transluminal coronary angioplasty (PTCA), has not been established.
RESEARCH DESIGN AND METHODS. All patients with type 2 diabetes and acute MI (n = 54) were prospectively enrolled into a study of immediate coronary angiography to guide PTCA of the occluded infarct vessel. Hospital and long-term course were assessed and compared with an unselected control group of nondiabetic patients (n = 358) who were enrolled in the same study.
RESULTS. Angiography showed that sites of occlusion and acute coronary flow were similar in both groups. Multivessel disease and shock were more common in type 2 diabetic versus nondiabetic patients: 69 vs. 51% and 21 vs. 10% (P< 0.02), respectively. Direct PTCA was successful in >90% in both groups. Mortality after 30 days was 13% in type 2 diabetic patients versus 5% in patients without diabetes (P< 0.04). Left ventricular (LV) ejection fraction before discharge was lower in diabetic patients (48 ± 17 vs. 55 ± 15%, P< 0.05). Mortality 1 year after discharge was 11 vs. 4% in diabetic versus nondiabetic patients (P< 0.02). Multivariate analysis identified type 2 diabetes as an independent risk factor for acute, but not for late, mortality.
CONCLUSIONS. Direct PTCA is safe and effective in type 2 diabetic patients with acute MI. Mortality after 30 days in unselected diabetic patients is <15% with this approach. Advanced disease and shock contribute to an increased mortality in type 2 diabetic patients with acute MI versus nondiabetic patients.
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About this article
Title

Type 2 Diabetes and Acute Myocardial Infarction. Angiographic Findings and Results of an Invasive Therapeutic Approach in Type 2 Diabetic Versus Nondiabetic Patients

Journal

Clinical Diabetology

Issue

Vol 1, No 1 (2000): Practical Diabetology

Pages

65-74

Published online

2000-09-26

Bibliographic record

Diabetologia Praktyczna 2000;1(1):65-74.

Authors

Bernd Waldecker
Wolfgang Waas
Werner Haberbosch
Reinhard Voss
Mary K. Steen-Müller
Anke Heidessen
Reinhard Bretzel
Harald Tilmanns

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