Prognostic impact of diabetes mellitus on patients managed by urgent percutaneous coronary intervention

Introduction: Diabetes Mellitus (DM) is known to be associated with worse outcomes following percutaneous coronary intervention (PCI). Aim: To assess prognostic impact of DM on patients managed by urgent PCI following ST-segment elevation myocardial infarction (STEMI). Methods: In a retrospective study, STEMI patients admitted to our department from January 2016 to December 2019 and treated with urgent PCI (primary or rescue PCI) were included. They were divided in two groups: Diabetic and non-diabetic patients. They were followed-up for a period of 12 months. Major cardiac adverse event (MACE) was a composite outcome of the following events: myocardial infarction, target vessel revascularization, target lesion revascularization or cardiovascular death. MACEs were collected during follow-up. Results: Our population consisted of 225 patients. DM was observed in 104 STEMI patients (46.2%). Diabetic patients had higher frequency of hypertension (p<0.001), low-density lipoprotein cholesterol levels > 1.4mmol/l (p<0.001) and chronic kidney disease (CKD) (p=0.009). In-hospital and 12-months 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). In-hospital and 12-months MACEs were also more frequent among diabetic patients (17.3% versus 6.7%; p=0.013) and (43.5% versus 17.5%; p<0.001). Main factors associated with in-hospital mortality among diabetic patients were age > 75 years, anemia, CKD, cardiogenic shock and procedural failure. Age > 75 years, hyperglycemia at admission (>10mmol/l), extensive anterior infarction and procedure failure were associated with in-hospital mortality in the non-diabetic group. Factors associated with 12-months mortality and MACEs among diabetic patients were age > 75 years, anemia, CKD and left ventricular systolic dysfunction. Conclusions: Despite modern era of STEMI treatment, diabetic patients still have a poor prognosis. These results highlight the need for coronary risk factors treatment among these patients.