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CLINICAL RESEARCH: INTERVENTIONAL CARDIOLOGY

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

Abhiram Prasad, MD, MRCP, FACC^*, Gregg W. Stone, MD, FACC^,*, Thomas D. Stuckey, MD, FACC, Costantino O. Costantini, MD, Peter J. Zimetbaum, MD, FACC, Michael McLaughlin, MD, Roxana Mehran, MD, FACC, Eulogio Garcia, MD^||, James E. Tcheng, MD, FACC^¶, David A. Cox, MD, FACC^#, Cindy L. Grines, MD, FACC^**, Alexandra J. Lansky, MD, FACC and Bernard J. Gersh, MBChB, DPhil, FACC^*

^* Division of Cardiovascular Diseases and Department of Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, Minnesota
Columbia University Medical Center and the Cardiovascular Research Foundation, New York, New York
Moses Cone Heart and Vascular Center, Greensboro, North Carolina
Beth Israel Deaconess Medical Center, Boston, Massachusetts
^|| Hospital Gregorio Maranon, Madrid, Spain
^¶ Duke Clinical Research Institute, Durham, North Carolina
^# Mid Carolina Cardiology, Charlotte, North Carolina
^** William Beaumont Hospital, Royal Oak, Michigan

Manuscript received September 7, 2004; revised manuscript received October 18, 2004, accepted October 26, 2004.

^* Reprint requests and correspondence: Dr. Gregg W. Stone, The Cardiovascular Research Foundation, Columbia University Medical Center, Herbert Irving Pavilion, 5th Floor, 161 Fort Washington Avenue, New York, New York 10032 (Email: gstone{at}crf.org).

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.

Abbreviations and Acronyms   AMI = acute myocardial infarction   CADILLAC = Controlled Abciximab and Device Investigation to Lower Late Angioplasty Complications trial   CI = confidence interval   HR = hazard ratio   MACE = major adverse cardiac events   MBG = myocardial blush grade   OR = odds ratio   PCI = percutaneous coronary intervention   STR = ST-segment resolution

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