Spontaneous reperfusion before intervention improves immediate but not long-term prognosis in diabetic patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease

Abstract

BACKGROUND: The presence of normal thrombolysis in myocardial infarction (TIMI) fl ow
grade 3 before percutaneous coronary intervention (PCI) is associated with better outcomes.
The aim of this study was to evaluate the association of spontaneous reperfusion (SR) before
PCI and its effect on the immediate and long-term outcomes in diabetic patients.

METHODS: A total of 1,850 patients with myocardial infarction and multivessel coronary artery
disease undergoing primary PCI were enrolled and divided into 4 groups: (1) patients with
diabetes mellitus (DM) and initial TIMI < 3 fl ow (n = 491), (2) patients with DM and initial
TIMI 3 fl ow (n = 48), (3) patients without DM and with initial TIMI < 3 fl ow (n = 1,196),
(4) patients without DM and with initial TIMI 3 fl ow (n = 115).

RESULTS: SR before PCI was similar in diabetic and non-diabetic patients (8.9% vs. 8.8%,
p = 0.8). DM was not an independent predictor of either pre-procedural or post-procedural
TIMI 3 fl ow. In-hospital mortality rate was the highest in group 1 and the lowest in group 4
(p < 0.0001). Death rates of patients from groups 2 and 3 were similar (approximately 8.3%
each, p = 0.9). Non-diabetic patients had a higher 1-year survival rate than diabetic patients,
irrespective of their initial TIMI fl ow.

CONCLUSIONS: SR is associated with a similar post-PCI improvement in epicardial blood fl ow
both in diabetic and non-diabetic patients. SR improves in-hospital survival of diabetic patients,
which is similar to the survival of non-diabetic patients without SR. The benefi cial effect
of SR in diabetic patients disappears during 1-year follow-up.