Fabris Enrico, Van't Hof Arnoud, Hamm Christian W, Lapostolle Frédéric, Lassen Jens Flensted, Goodman Shaun G, Ten Berg Jurriën M, Bolognese Leonardo, Cequier Angel, Chettibi Mohamed, Hammett Christopher J, Huber Kurt, Janzon Magnus, Merkely Béla, Storey Robert F, Zeymer Uwe, Cantor Warren J, Kerneis Mathieu, Diallo Abdourahmane, Vicaut Eric, Montalescot Gilles
Cardiology Department, Isala Heart Center, Zwolle, the Netherlands.
Cardiovascular Department, University of Trieste, Trieste, Italy.
Catheter Cardiovasc Interv. 2019 Jun 1;93(7):E369-E377. doi: 10.1002/ccd.27921. Epub 2018 Oct 9.
We investigated, in the contemporary era of ST-elevation myocardial infarction (STEMI) treatment, the influence of diabetes mellitus (DM) on cardiovascular outcomes, and whether pre-hospital administration of ticagrelor may affect these outcomes in a subgroup of STEMI patients with DM.
DM patients have high platelet reactivity and a prothrombotic condition which highlight the importance of an effective antithrombotic regimen in this high-risk population.
In toal 1,630 STEMI patients enrolled in the ATLANTIC trial who underwent primary percutaneous coronary intervention (PCI) were included. Multivariate analysis was used to explore the association of DM with outcomes and potential treatment-by-diabetes interaction was tested.
A total of 214/1,630 (13.1%) patients had DM. DM was an independent predictor of poor myocardial reperfusion as reflected by less frequent ST-segment elevation resolution (≥70%) after PCI (OR 0.59, 95% CI 0.43-0.82, P < 0.01) and was an independent predictor of the composite 30-day outcomes of death/new myocardial infarction (MI)/urgent revascularization/definite stent thrombosis (ST) (OR 2.80, 95% CI 1.62-4.85, P < 0.01), new MI or definite acute ST (OR 2.46, 95% CI 1.08-5.61, P = 0.03), and definite ST (OR 10.00, 95% CI 3.54-28.22, P < 0.01). No significant interaction between pre-hospital ticagrelor vs in-hospital ticagrelor administration and DM was present for the clinical, electrocardiographic and angiographic outcomes as well as for thrombolysis in myocardial infarction major bleeding.
DM remains independently associated with poor myocardial reperfusion and worse 30-day clinical outcomes. No significant interaction was found between pre-hospital vs in-hospital ticagrelor administration and DM status. Further approaches for the treatment of DM patients are needed.
clinicaltrials.gov identifier: NCT01347580.
在当代ST段抬高型心肌梗死（STEMI）治疗时代，我们研究了糖尿病（DM）对心血管结局的影响，以及院前给予替格瑞洛是否会影响STEMI合并DM患者亚组的这些结局。
DM患者血小板反应性高且处于血栓前状态，这凸显了在这一高危人群中采用有效抗栓方案的重要性。
纳入1630例参与ATLANTIC试验且接受了直接经皮冠状动脉介入治疗（PCI）的STEMI患者。采用多变量分析探讨DM与结局之间的关联，并检验糖尿病潜在的治疗交互作用。
共有214/1630（13.1%）例患者患有DM。DM是心肌再灌注不良的独立预测因素，表现为PCI后ST段抬高分辨率（≥70%）较低（OR 0.59，95%CI 0.43-0.82，P<0.01），并且是30天死亡/新发心肌梗死（MI）/紧急血运重建/明确支架血栓形成（ST）复合结局（OR 2.80，95%CI 1.62-4.85，P<0.01）、新发MI或明确急性ST（OR 2.46，95%CI 1.08-5.61，P = 0.03）以及明确ST（OR 10.00，95%CI 3.54-28.22，P<0.01）的独立预测因素。对于临床、心电图和血管造影结局以及心肌梗死溶栓大出血，院前与院内给予替格瑞洛之间与DM均不存在显著交互作用。
DM仍然独立地与心肌再灌注不良和更差的30天临床结局相关。院前与院内给予替格瑞洛之间与DM状态未发现显著交互作用。需要进一步探索DM患者的治疗方法。
clinicaltrials.gov标识符：NCT01347580。
