Key result
Primary PTCA is linked to ~71% lower death or reinfarction risk vs fibrinolysis in diabetic MI.
Why the study?
Does primary PTCA reduce death, non-fatal reinfarction, and target vessel revascularisation in diabetic patients with acute myocardial infarction compared to fibrinolytic treatment?
Observational (n=202)
No
Does primary PTCA reduce death, non-fatal reinfarction, and target vessel revascularisation in diabetic patients with acute myocardial infarction compared to fibrinolytic treatment?
Relative Risk: 0.29 (95% CI 0.15–0.57)
Absolute Event Rate: 17.5% vs 31.3%
p-value: p=0.02
Primary PTCA significantly reduces the risk of death or reinfarction at one year compared to fibrinolysis in diabetic patients presenting with acute myocardial infarction.
May support primary PTCA in diabetic AMI; hypothesis-generating and should not yet change practice.
OBJECTIVE: To compare the early and late outcomes of primary percutaneous transluminal coronary angioplasty (PTCA) with fibrinolytic treatment among diabetic patients with acute myocardial infarction (AMI). DESIGN: Retrospective observational study with data obtained from prospective registries. SETTING: Tertiary cardiovascular institution with 24 hour acute interventional facilities. PATIENTS: 202 consecutive diabetic patients with AMI receiving reperfusion treatment within six hours of symptom onset. INTERVENTIONS: Fibrinolytic treatment was administered to 99 patients, and 103 patients underwent primary PTCA. Most patients undergoing PTCA received adjunctive stenting (94.2%) and glycoprotein IIb/IIIa inhibition (63.1%). MAIN OUTCOME MEASURES: Death, non-fatal reinfarction, and target vessel revascularisation at 30 days and one year were assessed. RESULTS: Baseline characteristics were similar in these two treatment groups except that the proportion of patients with Killip class III or IV was considerably higher in those treated with PTCA (15.5% v 6.1%, p = 0.03) and time to treatment was significantly longer (103.7 v 68.0 minutes, p < 0.001). Among those treated with PTCA, the rates for in-hospital recurrent ischaemia (5.8% v 17.2%, p = 0.011) and target vessel revascularisation at one year (19.4% v 36.4%, p = 0.007) were lower. Death or reinfarction at one year was also reduced among those treated with PTCA (17.5% v 31.3%, p = 0.02), with an adjusted relative risk of 0.29 (95% confidence interval 0.15 to 0.57) compared with fibrinolysis. CONCLUSION: Among diabetic patients with AMI, primary PTCA was associated with reduced early and late adverse events compared with fibrinolytic treatment.
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Li‐Fern Hsu (2002) conducted an observational in Diabetes mellitus and acute myocardial infarction (n=202). Primary percutaneous transluminal coronary angioplasty (PTCA) vs. Fibrinolytic treatment was evaluated on Death or reinfarction at one year (adjusted RR 0.29, 95% CI 0.15 to 0.57, p=0.02). Primary PTCA reduced the risk of death or reinfarction at one year compared with fibrinolysis in diabetic patients with acute myocardial infarction (17.5% vs 31.3%; adjusted RR 0.29; P=0.02).
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