Nesrine Amdouni1, Ikram Chamtouri1, Asma Ben Abdallah1, Walid Jomaa1, Khaldoun Ben Hamda1, Faouzi Maatouk1
1CHU FAttouma Bourguiba Monastir, Monastir, Tunisia
Diabetes mellitus is a major cardiovascular risk factor. Acute myocardial infarction (AMI) is a common cardiovascular complication and is the leading cause of death in diabetic patients even in the primary coronary angioplasty intervention (PCI) era.
The aim of this study is to determine the impact of diabetes mellitus inclinical outcomes on patients undergoing PCI for AMI.
We retrospectively included 352 patients with AMI treated with PCI, enrolled between january 2000 and march 2017 in Cardiology B department of Fattouma Bourguiba university hospital.
Diabetes mellitus was present in 115 (32.7%) patients. Mean age was similar in diabetic (59.8 ± 10 years) and non diabetic patients (60.2 ± 12 years). Compared to non diabetic patients, whom with diabetes were more often female (44.6% vs 30.4% ; p= 0.0029). They had more comorbidities : essential hypertension (51.9% vs 24.6% ; p <0.0001), hyperlipidemia ( 21.7% vs 14.5% ; p= 0.0010), cerebrovascular accident ( 4.3% vs 1.3% ; p= 0.0015) and heart failure (4.8% vs 2.1% ; p= 0.0049). They have more frequently a history of coronary disease ( 43.6% vs 31.7% ; p= 0.0012), prior PCI ( 7% vs 4.6% ; p= 0.0023) and were more likely to be smokers ( 62.4% vs 42.2% ; p= 0.0020). Diabetic patients had longer onset to presentation : 21.8% vs 14.8% consult after 6 hours from symptom onset. They were equally likely to have anterior myocardial infarction ( 50.4% vs 52.7% ; p= NS) but more likely to present left ventricular failure at admission ( 18.3% vs 11.4% ; p= 0.0047). Patients with diabetes had higher rates of shock (18.4% vs 7.2% ; p= 0.002) and severe ventricular arythmia (13.9% vs 11% ; p= NS) after PCI. During the index hospitalization, diabetic patients were more likely to die ( 7.7% vs 4.3% p<0.0001).
Diabetics patients undergoing PCI for AMI have worse baseline clinical features and unfavorable in-hospital and after PCI outcomes compared to non diabetic patients.