REVIEW ARTICLES
Emerging concepts in the management of acute myocardial infarction in patients with diabetes mellitus
Koon-Hou Mak, MBBS* and
Eric J. Topol, MD
* Department of Cardiology, National Heart Centre, Singapore
Department of Cardiology, Joseph J. Jacobs for Thrombosis and Vascular Biology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Manuscript received June 22, 1999;
revised manuscript received October 25, 1999,
accepted November 17, 1999.
Reprint requests and correspondence: Dr. Eric J. Topol, Department of Cardiology, F25, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, Ohio 44195
topole{at}ccf.org
Although fibrinolysis has improved survival of patients after myocardial infarction (MI), such therapy is less likely to be administered to patients with diabetes. Furthermore, these patients present later (15 min) than nondiabetics. Moreover, even with the use of early potent fibrinolytic agents, patients with diabetes continued to suffer excessive morbidity and mortality. This finding is not related to the ability of fibrinolytic agents to restore complete reperfusion or increased risk of reocclusion of the infarct-related artery. Instead, the impaired ventricular performance at the noninfarct areas and metabolic derangements during the acute phase of MI may account for the adverse outcome. The efficacy of percutaneous coronary revascularization procedures for treatment of acute MI requires further evaluation. Therapeutic approaches should consider correcting these abnormalities to afford greater survival benefit for this subset of high-risk patients.
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Abbreviations and Acronyms
| | AMI | = acute myocardial infarction | | ATP | = adenosine triphosphate | | CI | = confidence interval | | FFA | = free fatty acids | | GIK | = glucose-insulin-potassium | | GUSTO-I | = Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries | | MI | = myocardial infarction | | PTCA | = percutaneous transluminal coronary angioplasty | | SAVE | = Survival and Ventricular Enlargement Study | | TIMI | = Thrombolysis in Myocardial Infarction |
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