Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction

Abhiram Prasad, Gregg W. Stone, Thomas D. Stuckey, Costantino O. Costantini, Peter J. Zimetbaum, Michael McLaughlin, Roxana Mehran, Eulogio Garcia, James E. Tcheng, David A. Cox, Cindy L. Grines, Alexandra J. Lansky, Bernard J. Gersh

Research output: Contribution to journalArticle

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Abstract

OBJECTIVES: We investigated the impact of diabetes mellitus on myocardial perfusion after primary percutaneous coronary intervention (PCI) utilizing myocardial blush grade (MBG) and ST-segment elevation resolution (STR). BACKGROUND: Diabetes is an independent predictor of outcomes after primary PCI for acute myocardial infarction (AMI). Whether the poor prognosis is due to lower rates of myocardial reperfusion is unknown. METHODS: Reperfusion success in those with and without diabetes mellitus was determined by measuring MBG (n = 1,301) and STR analysis (n = 700) in two substudies of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial among patients undergoing primary PCI for AMI. RESULTS: There were no differences between those with or without diabetes with regard to postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (>95%), distribution of infarct-related artery, and the frequency of stent deployment or abciximab administration. Patients with diabetes mellitus were more likely to have absent myocardial perfusion (MBG 0/1, 56.0% vs. 47.1%, p = 0.01) and absent STR (20.3% vs. 8.1%, p = 0.002). Diabetes mellitus (hazard ratio [HR] 1.63 [95% confidence interval (CI) 1.17 to 2.28], p = 0.004) was an independent predictor of absent myocardial perfusion (MBG 0/1) and absent STR (HR 2.94 [95% CI 1.64 to 5.37], p = 0.005) by multivariate modeling. CONCLUSIONS: Despite similar high rates of TIMI flow grade 3 after primary PCI in patients with and without diabetes, patients with diabetes are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG. Diminished microvascular perfusion in diabetics after primary PCI may contribute to adverse outcomes.

Original languageEnglish (US)
Pages (from-to)508-514
Number of pages7
JournalJournal of the American College of Cardiology
Volume45
Issue number4
DOIs
StatePublished - Feb 15 2005

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Percutaneous Coronary Intervention
Angioplasty
Diabetes Mellitus
Perfusion
Myocardial Infarction
Confidence Intervals
Myocardial Reperfusion
Reperfusion
Stents
Arteries
Equipment and Supplies
abciximab

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Prasad, A., Stone, G. W., Stuckey, T. D., Costantini, C. O., Zimetbaum, P. J., McLaughlin, M., ... Gersh, B. J. (2005). Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. Journal of the American College of Cardiology, 45(4), 508-514. https://doi.org/10.1016/j.jacc.2004.10.054

Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. / Prasad, Abhiram; Stone, Gregg W.; Stuckey, Thomas D.; Costantini, Costantino O.; Zimetbaum, Peter J.; McLaughlin, Michael; Mehran, Roxana; Garcia, Eulogio; Tcheng, James E.; Cox, David A.; Grines, Cindy L.; Lansky, Alexandra J.; Gersh, Bernard J.

In: Journal of the American College of Cardiology, Vol. 45, No. 4, 15.02.2005, p. 508-514.

Research output: Contribution to journalArticle

Prasad, A, Stone, GW, Stuckey, TD, Costantini, CO, Zimetbaum, PJ, McLaughlin, M, Mehran, R, Garcia, E, Tcheng, JE, Cox, DA, Grines, CL, Lansky, AJ & Gersh, BJ 2005, 'Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction', Journal of the American College of Cardiology, vol. 45, no. 4, pp. 508-514. https://doi.org/10.1016/j.jacc.2004.10.054
Prasad, Abhiram ; Stone, Gregg W. ; Stuckey, Thomas D. ; Costantini, Costantino O. ; Zimetbaum, Peter J. ; McLaughlin, Michael ; Mehran, Roxana ; Garcia, Eulogio ; Tcheng, James E. ; Cox, David A. ; Grines, Cindy L. ; Lansky, Alexandra J. ; Gersh, Bernard J. / Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction. In: Journal of the American College of Cardiology. 2005 ; Vol. 45, No. 4. pp. 508-514.
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abstract = "OBJECTIVES: We investigated the impact of diabetes mellitus on myocardial perfusion after primary percutaneous coronary intervention (PCI) utilizing myocardial blush grade (MBG) and ST-segment elevation resolution (STR). BACKGROUND: Diabetes is an independent predictor of outcomes after primary PCI for acute myocardial infarction (AMI). Whether the poor prognosis is due to lower rates of myocardial reperfusion is unknown. METHODS: Reperfusion success in those with and without diabetes mellitus was determined by measuring MBG (n = 1,301) and STR analysis (n = 700) in two substudies of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial among patients undergoing primary PCI for AMI. RESULTS: There were no differences between those with or without diabetes with regard to postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (>95{\%}), distribution of infarct-related artery, and the frequency of stent deployment or abciximab administration. Patients with diabetes mellitus were more likely to have absent myocardial perfusion (MBG 0/1, 56.0{\%} vs. 47.1{\%}, p = 0.01) and absent STR (20.3{\%} vs. 8.1{\%}, p = 0.002). Diabetes mellitus (hazard ratio [HR] 1.63 [95{\%} confidence interval (CI) 1.17 to 2.28], p = 0.004) was an independent predictor of absent myocardial perfusion (MBG 0/1) and absent STR (HR 2.94 [95{\%} CI 1.64 to 5.37], p = 0.005) by multivariate modeling. CONCLUSIONS: Despite similar high rates of TIMI flow grade 3 after primary PCI in patients with and without diabetes, patients with diabetes are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG. Diminished microvascular perfusion in diabetics after primary PCI may contribute to adverse outcomes.",
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T1 - Impact of diabetes mellitus on myocardial perfusion after primary angioplasty in patients with acute myocardial infarction

AU - Prasad, Abhiram

AU - Stone, Gregg W.

AU - Stuckey, Thomas D.

AU - Costantini, Costantino O.

AU - Zimetbaum, Peter J.

AU - McLaughlin, Michael

AU - Mehran, Roxana

AU - Garcia, Eulogio

AU - Tcheng, James E.

AU - Cox, David A.

AU - Grines, Cindy L.

AU - Lansky, Alexandra J.

AU - Gersh, Bernard J.

PY - 2005/2/15

Y1 - 2005/2/15

N2 - OBJECTIVES: We investigated the impact of diabetes mellitus on myocardial perfusion after primary percutaneous coronary intervention (PCI) utilizing myocardial blush grade (MBG) and ST-segment elevation resolution (STR). BACKGROUND: Diabetes is an independent predictor of outcomes after primary PCI for acute myocardial infarction (AMI). Whether the poor prognosis is due to lower rates of myocardial reperfusion is unknown. METHODS: Reperfusion success in those with and without diabetes mellitus was determined by measuring MBG (n = 1,301) and STR analysis (n = 700) in two substudies of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial among patients undergoing primary PCI for AMI. RESULTS: There were no differences between those with or without diabetes with regard to postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (>95%), distribution of infarct-related artery, and the frequency of stent deployment or abciximab administration. Patients with diabetes mellitus were more likely to have absent myocardial perfusion (MBG 0/1, 56.0% vs. 47.1%, p = 0.01) and absent STR (20.3% vs. 8.1%, p = 0.002). Diabetes mellitus (hazard ratio [HR] 1.63 [95% confidence interval (CI) 1.17 to 2.28], p = 0.004) was an independent predictor of absent myocardial perfusion (MBG 0/1) and absent STR (HR 2.94 [95% CI 1.64 to 5.37], p = 0.005) by multivariate modeling. CONCLUSIONS: Despite similar high rates of TIMI flow grade 3 after primary PCI in patients with and without diabetes, patients with diabetes are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG. Diminished microvascular perfusion in diabetics after primary PCI may contribute to adverse outcomes.

AB - OBJECTIVES: We investigated the impact of diabetes mellitus on myocardial perfusion after primary percutaneous coronary intervention (PCI) utilizing myocardial blush grade (MBG) and ST-segment elevation resolution (STR). BACKGROUND: Diabetes is an independent predictor of outcomes after primary PCI for acute myocardial infarction (AMI). Whether the poor prognosis is due to lower rates of myocardial reperfusion is unknown. METHODS: Reperfusion success in those with and without diabetes mellitus was determined by measuring MBG (n = 1,301) and STR analysis (n = 700) in two substudies of the Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications (CADILLAC) trial among patients undergoing primary PCI for AMI. RESULTS: There were no differences between those with or without diabetes with regard to postprocedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 (>95%), distribution of infarct-related artery, and the frequency of stent deployment or abciximab administration. Patients with diabetes mellitus were more likely to have absent myocardial perfusion (MBG 0/1, 56.0% vs. 47.1%, p = 0.01) and absent STR (20.3% vs. 8.1%, p = 0.002). Diabetes mellitus (hazard ratio [HR] 1.63 [95% confidence interval (CI) 1.17 to 2.28], p = 0.004) was an independent predictor of absent myocardial perfusion (MBG 0/1) and absent STR (HR 2.94 [95% CI 1.64 to 5.37], p = 0.005) by multivariate modeling. CONCLUSIONS: Despite similar high rates of TIMI flow grade 3 after primary PCI in patients with and without diabetes, patients with diabetes are more likely to have abnormal myocardial perfusion as assessed by both incomplete STR and reduced MBG. Diminished microvascular perfusion in diabetics after primary PCI may contribute to adverse outcomes.

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