PMID- 19447835
OWN - NLM
STAT- MEDLINE
DCOM- 20091201
LR  - 20171116
IS  - 1468-201X (Electronic)
IS  - 1355-6037 (Linking)
VI  - 95
IP  - 16
DP  - 2009 Aug
TI  - Benefit of angiographic spontaneous reperfusion in STEMI: does it extend to 
      diabetic patients?
PG  - 1331-6
LID - 10.1136/hrt.2008.160390 [doi]
AB  - BACKGROUND: Spontaneous reperfusion (SR) in ST elevation myocardial infarction 
      (STEMI) improves clinical outcome, yet its incidence and impact among diabetic 
      patients is unclear. OBJECTIVE: To carry out a systematic analysis of SR in the 
      diabetic cohort of a large primary percutaneous coronary intervention 
      (PCI)-treated population with STEMI. METHODS AND RESULTS: 4944 patients (15.5% 
      diabetic) undergoing primary PCI in the APEX AMI study were evaluated. SR defined 
      as pre-PCI Thrombolysis in Myocardial Infarction (TIMI) 3 flow occurred in 11.5% 
      of patients; it was more common in non-diabetic (11.9%) than in diabetic patients 
      (9.2%) (p = 0.028). Patients with SR versus no SR had improved post-PCI TIMI 3 
      flow: in non-diabetic patients (99.8% vs 90.3%, p<0.001) and in diabetic patients 
      (98.6% vs 84.9%, p<0.001). Non-diabetic patients with SR showed a significant 
      improvement in 90-day death/shock/congestive heart failure (CHF) compared with 
      those without SR: 4.4% versus 8.9% (p = 0.001), respectively. The composite 
      outcome in diabetic patients with versus without SR was 10.0% versus 14.9% (p = 
      0.270), respectively. When outcomes were examined according to tertiles of 
      baseline blood glucose, both non-diabetic and diabetic patients with 
      normoglycaemia showed higher SR rates (15.5%, 10.3%, 7.3% for non-diabetic 
      patients, p<0.001; 17.4%, 7.2%, 9.1% for diabetic patients, p = 0.132), greater 
      ST resolution (55.4%, 52.6%, 49.7% for non-diabetic patients, p = 0.030; 50%, 
      46.4%, 39.1% for diabetic patients, p = 0.179), and improved 90-day 
      death/shock/CHF (5.2%, 8.3%, 14% for non-diabetic patients p<0.001; 8.7%, 4.2%, 
      15.8% for diabetic patients, p = 0.006). CONCLUSIONS: These data indicate that SR 
      is less common in diabetic patients with STEMI. Diabetic patients without SR have 
      worse post-PCI epicardial patency, which contributes to adverse outcomes. 
      Diabetic patients with normal baseline blood glucose and SR have enhanced 
      epicardial flow after PCI and improved prognosis.
FAU - Bainey, K R
AU  - Bainey KR
AD  - University of Alberta, Edmonton, Alberta, Canada.
FAU - Fu, Y
AU  - Fu Y
FAU - Granger, C B
AU  - Granger CB
FAU - Hamm, C W
AU  - Hamm CW
FAU - Holmes, D R Jr
AU  - Holmes DR Jr
FAU - O'Neill, W W
AU  - O'Neill WW
FAU - Seabra-Gomes, R
AU  - Seabra-Gomes R
FAU - Pfisterer, M E
AU  - Pfisterer ME
FAU - Van de Werf, F
AU  - Van de Werf F
FAU - Armstrong, P W
AU  - Armstrong PW
CN  - APEX AMI Investigators
LA  - eng
PT  - Journal Article
PT  - Randomized Controlled Trial
PT  - Research Support, Non-U.S. Gov't
DEP - 20090515
PL  - England
TA  - Heart
JT  - Heart (British Cardiac Society)
JID - 9602087
RN  - 0 (Antibodies, Monoclonal)
RN  - 0 (Antibodies, Monoclonal, Humanized)
RN  - 0 (Single-Chain Antibodies)
RN  - 0 (Vasodilator Agents)
RN  - CHZ6OLQ3UU (pexelizumab)
SB  - IM
MH  - Aged
MH  - Antibodies, Monoclonal/therapeutic use
MH  - Antibodies, Monoclonal, Humanized
MH  - Coronary Angiography/methods
MH  - Diabetic Angiopathies/diagnostic imaging/mortality/*therapy
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Myocardial Infarction/diagnostic imaging/mortality/*therapy
MH  - Myocardial Reperfusion/*methods/mortality
MH  - Remission, Spontaneous
MH  - Single-Chain Antibodies
MH  - Treatment Outcome
MH  - Vasodilator Agents/therapeutic use
EDAT- 2009/05/19 09:00
MHDA- 2009/12/16 06:00
CRDT- 2009/05/19 09:00
PHST- 2009/05/19 09:00 [entrez]
PHST- 2009/05/19 09:00 [pubmed]
PHST- 2009/12/16 06:00 [medline]
AID - hrt.2008.160390 [pii]
AID - 10.1136/hrt.2008.160390 [doi]
PST - ppublish
SO  - Heart. 2009 Aug;95(16):1331-6. doi: 10.1136/hrt.2008.160390. Epub 2009 May 15.