Author + information
- Dominika Klimczak1,
- Mariusz Tomaniak2,
- Maria Tovar3,
- Joost Daemen4,
- Jeroen Wilschut5,
- Peter de Jaegere6,
- Felix Zijlstra7,
- Nicolas Van Mieghem8 and
- Roberto Diletti9
- 1Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, Department of Immunology, Transplant Medicine and Internal Diseases, Division of Heart Failure and Cardiac Rehabilitation, Warsaw, Poland
- 2Thorax Center, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands, Medical University of Warsaw, First Department of Cardiology, Warsaw, Poland
- 3Thorax Centre, Erasmus MC, Department of Interventional Cardiology, Rotterdam, Netherlands
- 4Erasmus MC - Thoraxcenter, United States
- 5Thoraxcenter Erasmus MC, Rotterdam, Netherlands
- 6Department of Cardiology, Erasmus MC, Rotterdam, Netherlands
- 7Thoraxcenter, Erasmus Medical Centre, Rotterdam, Netherlands
- 8Thoraxcenter, Erasmus Medical Center, Rotterdam, Netherlands
- 9Thorax Center, Erasmus MC, Rotterdam, Netherlands
Optimal strategy for non-culprit lesion revascularization in patients presenting with ST-segment elevation myocardial infarction (STEMI) and multi-vessel disease remains controversial particularly in diabetic population.
This is an observational, single-centre study evaluating the impact of incomplete revascularization on clinical outcomes in diabetic and non-diabetic patients presenting with STEMI and multi-vessel disease. Clinical outcomes are reported at one year post primary PCI.
A total of 761 patients with a minimum follow up of one year were evaluated. DM was diagnosed in 109 (14.3%) subjects, of whom 40 (36.7%) were on insulin therapy. Diabetes patients had more hypertension (69.7% vs. 37.1%, p = 0.001), chronic kidney disease (85.3% vs.14.7%, p = 0.001)] and three-vessel disease (29.1% vs.48.6%, p = 0.001). A total of 88 diabetes patients and 472 patients in non-diabetic subgroup (p = 0.067) had at least one non-revascularized coronary stenosis after either index culprit only (72.5% vs. 63.8%, p=0,.079), ad-hoc (11.9% vs. 15.8%, p = 0.278) or staged procedure (15.6% vs. 20.4%, p = 0.243). At one-year follow-up, incomplete revascularization was associated with higher mortality (13.6% vs. 5.7%, p = 0.006), re-infarction (8.0% vs 3.4%, p = 0.037) and MACE rates (31.8 vs. 22%, p = 0.044) in diabetes patients compared to non-diabetic patients. Complete coronary revascularization was associated with similar survival (4.8% vs. 3.9%, p = 0.833) re-infarction rates (0 % vs. 1.7% p = 0.555) and MACE rate (4.8% vs. 6.1%, p = 0.827) in both groups.
Among diabetic patients presenting with STEMI and multi-vessel disease incomplete revascularization is associated with higher rate of events at one year follow up compared with non-diabetic patients. Complete revascularization could mitigate the differences in terms of clinical outcomes between the two groups.