Abstract 10737: The Impact of Diabetes on Percutaneous Coronary Intervention Outcomes in STEMI Patients: The Asia-Pacific Evaluation of Cardiovascular Therapies (ASPECT) Collaboration

Abstract

Introduction: Diabetes is associated with poorer outcomes and increased complication rates in STEMI patients undergoing percutaneous coronary intervention (PCI). Regional variations have been described but data are notably lacking in the Asia-Pacific region. Aims: We report the associations of diabetes with clinical characteristics and outcomes in STEMI patients undergoing PCI across the Asia-Pacific. Methods: The Asia Pacific Evaluation of Cardiovascular Therapies (ASPECT) collaboration consists of data from the registries of contributing PCI centres across Australia, Hong Kong, Singapore, Malaysia, Indonesia and Vietnam. Clinical characteristics, lesion characteristics, and outcomes were provided for STEMI patients. Key outcomes included overall mortality at 30 days, and major adverse cardiovascular events (MACE; defined as peri-procedural myocardial infarctions, emergency CABG, stent thrombosis, target vessel revascularisation, cerebrovascular events, or death) at 30 days. Results: A total of 12,144 STEMI patients (mean(SD) age 59.3(12.3)) were included, of which 3912 (32.2%) had diabetes. Patients with diabetes were likely to be older, have a history of cardiovascular disease and previous acute coronary events (all p<0.05). They were also more likely to present with out-of-hospital cardiac arrest, require mechanical ventricular support and have lower estimated ejection fractions (all p<0.05). With regards to lesion characteristics, diabetic patients had a higher rate of multi-vessel disease, type C ACC-AHA lesions and diffuse lesions >20mm (all p<0.05). After adjustment for demographics, clinical presentation, lesion characteristics and procedural factors, diabetes was significantly associated with increased 30 day mortality (9.6%vs 5.5%, OR 1.70 (95% CI 1.33-2.18)) and 30-day MACE rates (13.3% vs 8.6%, OR 1.68 (95% CI 1.4-2.02)). Further analyses investigated inter-regional variations in this association. Conclusions: Diabetes portends poorer clinical outcomes in STEMI patients undergoing PCI in the Asia-Pacific. The development of effective preventative measures and interventional strategies targeted at this high-risk group is crucial.