A comparison between diabetic and non-diabetic patients on Short and mid-term prognosis following STEMI treated with Primary PCI

Abstract

Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are at high risk for recurrent cardiovascular events. The main objectives of our study were to assess the short and mid-term prognosis of diabetic patients following STEMI and to identify the prognostic factors. All patients with STEMI treated with PCI from 2018 until 2019 were prospectively enrolled. Subjects were classified according to DM and followed up to 12 months. Our population consisted of 225 patients. Diabetes was observed in 104 STEMI patients. Patients with diabetes had higher prevalence of hypertension ( P < 0,001), hypercholesterolemia ( P < 0,001) and chronic kidney disease ( P = 0,009). Intra-hospital and one-year mortality were significantly higher in the diabetic group, 11,5% versus 4,1% ( P = 0,036) and 24,7% versus 8,7% ( P = 0,003) respectively. Major adverse cardiac events (MACEs) during the hospital stay and at one-year follow-up were also more frequent in the diabetic group, 17,3% versus 6,7% ( P = 0,013) and 43,5% versus 17,5% ( P < 0,001) respectively. Main factors associated with intra-hospital mortality in patients with DM were age more than 75 years, anemia, kidney failure, cardiogenic shock and procedural failure. Age more than 75 years, hyperglycemia at admission (more than 10 mmol/l), extensive anterior infarction and procedure failure were associated with intra-hospital mortality in the non-diabetic group. Factors associated with one-year mortality in patients with diabetes were an age more than 75 years, anemia, kidney failure, left ventricular systolic dysfunction and high level of troponin. These same factors were also associated with a higher rate of MACEs during 12 months follow-up in patients with DM. Despite new advances in the treatment of STEMI, diabetic patients still have a poor prognosis compared to non-diabetic patients. Our results emphasize the need to treat coronary risk factors among diabetic patients.