Document Detail

Type 2 diabetes and acute myocardial infarction. Angiographic findings and results of an invasive therapeutic approach in type 2 diabetic versus nondiabetic patients.
MedLine Citation:
PMID:  10546016     Owner:  NLM     Status:  MEDLINE    
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.
B Waldecker; W Waas; W Haberbosch; R Voss; M K Steen-Müller; A Hiddessen; R Bretzel; H Tillmanns
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article    
Journal Detail:
Title:  Diabetes care     Volume:  22     ISSN:  0149-5992     ISO Abbreviation:  Diabetes Care     Publication Date:  1999 Nov 
Date Detail:
Created Date:  1999-12-08     Completed Date:  1999-12-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  7805975     Medline TA:  Diabetes Care     Country:  UNITED STATES    
Other Details:
Languages:  eng     Pagination:  1832-8     Citation Subset:  IM    
Department of Medicine, Justus-Liebig University, Giessen, Germany.
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MeSH Terms
Angioplasty, Transluminal, Percutaneous Coronary
Coronary Angiography
Diabetes Mellitus, Type 2 / complications*,  mortality
Diabetic Angiopathies / complications*,  mortality,  radiography
Feasibility Studies
Follow-Up Studies
Middle Aged
Myocardial Infarction / etiology*,  mortality,  radiography
Proportional Hazards Models
Regression Analysis

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