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J Am Coll Cardiol, 2000; 35:563-568
© 2000 by the American College of Cardiology Foundation
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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{dagger}

* Department of Cardiology, National Heart Centre, Singapore
{dagger} 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.

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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