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Diabetes Care, Vol 22, Issue 11 1832-1838, Copyright © 1999 by American Diabetes Association
Type 2 diabetes and acute myocardial infarction. Angiographic findings and results of an invasive therapeutic approach in type 2 diabetic versus nondiabetic patients
B Waldecker, W Waas, W Haberbosch, R Voss, MK Steen-Muller, A Hiddessen, R Bretzel and H Tillmanns
Department of Medicine, Justus-Liebig University, Giessen, Germany. bernd.waldecker@innere.med.uni-giessen.de
OBJECTIVE: Mortality in diabetic patients with acute myocardial infarction
(MI) is high. The significance of the pretreatment coronary status in type
2 diabetic patients with acute MI, as well as the effect of mechanical
revascularization using percutaneous transluminal coronary angioplasty
(PTCA), has not been established. RESEARCH DESIGN AND METHODS: All patients
with type 2 diabetes and acute MI (n = 54) were prospectively enrolled into
a study of immediate coronary angiography to guide PTCA of the occluded
infarct vessel. Hospital and long-term course were assessed and compared
with an unselected control group of nondiabetic patients (n = 358) who were
enrolled in the same study. RESULTS: Angiography showed that sites of
occlusion and acute coronary flow were similar in both groups. Multivessel
disease and shock were more common in type 2 diabetic versus nondiabetic
patients: 69 vs. 51% and 21 vs. 10% (P < 0.02), respectively. Direct
PTCA was successful in > 90% in both groups. Mortality after 30 days was
13% in type 2 diabetic patients versus 5% in patients without diabetes (P
< 0.04). Left ventricular (LV) ejection fraction before discharge was
lower in diabetic patients (48 +/- 17 vs. 55 +/- 15%, P < 0.05).
Mortality 1 year after discharge was 11 vs. 4% in diabetic versus
nondiabetic patients (P < 0.02). Multivariate analysis identified type 2
diabetes as an independent risk factor for acute, but not for late,
mortality. CONCLUSIONS: Direct PTCA is safe and effective in type 2
diabetic patients with acute MI. Mortality after 30 days in unselected
diabetic patients is < 15% with this approach. Advanced disease and
shock contribute to an increased mortality in type 2 diabetic patients with
acute MI versus nondiabetic patients.

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Copyright © 1999 by the American Diabetes Association.
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