Key result
Staged complete revascularization in diabetic patients with myocardial infarction resulted in a lower rate of cardiac death compared to culprit-only repair (6.5% vs 17.7%; p ≤ 0.05).
Why the study?
The benefit of complete revascularization in diabetic patients with myocardial infarction remains unclear, prompting this study to determine the optimal revascularization strategy.
Does staged complete revascularization reduce readmission, cardiac deaths, nonfatal myocardial re-infarction, and overall mortality in diabetic patients with acute myocardial infarction compared to culprit-only revascularization?
Cohort (n=393)
No
Does staged complete revascularization reduce readmission, cardiac deaths, nonfatal myocardial re-infarction, and overall mortality in diabetic patients with acute myocardial infarction compared to culprit-only revascularization?
Absolute Event Rate: 6.5% vs 17.7%
p-value: p=≤ 0.05
In diabetic patients with acute myocardial infarction, staged complete revascularization is associated with a lower incidence of cardiac death compared to culprit-lesion-only PCI.
Staged complete revascularization was associated with fewer events in diabetic MI; leaves open confirmation versus culprit-only in randomized trials.
INTRODUCTION: The benefit of complete revascularization in diabetic patients with myocardial infarction remains unclear. this study aims to find the optimal strategy of total vascular repair for diabetic patients with acute myocardial infarction. METHODS: In an analysis of a cohort, we assigned diabetic patients with myocardial infarction who were undergoing percutaneous coronary intervention (PCI) of the culprit lesion to receive either staged complete revascularization of nonculprit lesions or to receive no further revascularization in Madani Hospital (Tabriz, Iran). Functionally significant nonculprit lesions were identified either by angiography. The primary outcome was rates of readmission, cardiac deaths, nonfatal myocardial re-infarction, and overall mortality at 1 year. RESULTS: In our center, a total of 1186 patients underwent primary-PCI treatment, among which 521 were diagnosed with diabetes. Ultimately, 393 patients were selected for inclusion in the study. Within this cohort, 271 individuals (68.9%) underwent repair of only the culprit vessels (group 1), while 122 individuals (31.1%) received a comprehensive staged restoration of the vessels (group 2). During this time, group 1 in comparison with group 2 experienced 204 (75.3%) versus 97 (79.5%) cases of readmission, 48 (17.7%) versus 8 (6.5%) instances of cardiac death, 22 (8.1%) versus 18 (14.7%) occurrences of nonfatal myocardial re-infarction. Notably, the incidence of cardiac death in group 2 were significantly lower than that in group 1 (p ≤ 0.05). CONCLUSIONS: For individuals diagnosed with diabetes, staged complete revascularization demonstrated a lower frequency of readmission, cardiac deaths, nonfatal myocardial reinfarction, and overall mortality, in contrast to revascularization that targeted only the culprit lesion.
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Aslanabadi et al. (2024) conducted a cohort in Diabetic patients with acute myocardial infarction (n=393). Staged complete revascularization of nonculprit lesions vs. Repair of only the culprit vessels was evaluated on Rates of readmission, cardiac deaths, nonfatal myocardial re-infarction, and overall mortality at 1 year (p=≤ 0.05). Staged complete revascularization in diabetic patients with myocardial infarction resulted in a lower rate of cardiac death compared to culprit-only repair (6.5% vs 17.7%; p ≤ 0.05).
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