Does Reperfusion in the Treatment of Acute Myocardial Infarction Improve the Prognosis of Acute Myocardial Infarction in Diabetic Patients?

Background Diabetic patients have a 6‐fold increased mortality in acute coronary syndromes. Hypothesis Different therapeutic strategies in diabetics with acute coronary syndromes have an impact on in‐hospital and long‐term prognosis. Methods A total of 889 consecutive patients with ST‐segment elevation myocardial infarction were included and followed‐up for at least 6 months. The study population consisted of 168 (18.9%) diabetic patients and 721 nondiabetics. Results Invasive therapy and fibrinolysis were less frequently used in diabetic patients (38.7% versus 50.2%; p = 0.0071 and 8.3% versus 15%; p = 0.024, respectively). In‐hospital mortality in diabetic individuals was almost twice as high as in nondiabetic subjects (20.2% versus 11.1%; p < 0.0014). In‐hospital mortality was slightly higher in diabetic patients undergoing primary percutaneous transluminal coronary angioplasty (PTCA; 8.3% versus 4.8%; p = 0.35), but lower in those treated with fibrinolysis (7.7% versus 16%; p = 0.7) compared with the rest of the patients. At 6‐mo follow‐up mortality was significantly higher in diabetic subjects as compared with nondiabetic subjects (28.0% versus 15.1%; p < 0.0001). The highest number of deaths was found in individuals receiving conservative treatment with diabetic subjects significantly outnumbering nondiabetic individuals (40.1% versus 27.9%; p = 0.028 at 6 mo). Both in‐hospital and 6‐mo mortality were similar in diabetics and nondiabetics receiving reperfusion therapy (7.1% versus 8.2%; p < 0.68 and 9.3% versus 15.3%; p < 0.098, respectively). Conclusion Reperfusion therapy, both fibrinolysis and the invasive approach, reduced in‐hospital mortality from that observed in nondiabetic individuals. Copyright © 2009 Wiley Periodicals, Inc.