Jakob Philipp, Varbella Ferdinando, Linke Axel, Schwarz Bettina, Felix Stephan B, Seiffert Moritz, Kesterke Rahel, Nordbeck Peter, Witzenbichler Bernhard, Lang Irene M, Kessler Mirjam, Valina Christian, Dibra Alban, Rohla Miklos, Moccetti Marco, Vercellino Matteo, Gaede Luise, Bott-Flügel Lorenz, Stehli Julia, Candreva Alessandro, Paneni Francesco, Templin Christian, Schindler Matthias, Wischnewsky Manfred, Zanda Greca, Quadri Giorgio, Mangner Norman, Toma Aurel, Magnani Giulia, Clemmensen Peter, Lüscher Thomas F, Münzel Thomas, Schulze P Christian, Laugwitz Karl-Ludwig, Rottbauer Wolfgang, Huber Kurt, Neumann Franz-Josef, Schneider Steffen, Riemer Thomas, Weidinger Franz, Achenbach Stephan, Richardt Gert, Kastrati Adnan, Ford Ian, Ruschitzka Frank, Stähli Barbara E
Department of Cardiology, University Heart Center, University Hospital Zurich, Center for Translational and Experimental Cardiology (CTEC), University of Zurich, Rämistrasse 100, 8091, Zurich, Switzerland.
Interventional Cardiology Unit, Degli Infermi Hospital, Rivoli, Turin, Italy.
Clin Res Cardiol. 2025 Sep 10. doi: 10.1007/s00392-025-02745-x.
Diabetic patients with ST-segment elevation myocardial infarction (STEMI) are at an increased risk of cardiovascular events as compared to non-diabetic patients. This analysis investigated outcomes of diabetic patients presenting with multivessel disease (MVD) and STEMI in a contemporary trial and the relevance of an immediate versus staged multivessel PCI strategy in this high-risk population.
Patients enrolled in the MULTISTARS AMI trial were stratified according to the presence/absence of diabetes. Baseline characteristics and outcomes of diabetic and non-diabetic patients were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year.
In the MULTISTARS AMI trial, out of a total of 840 patients, 131 (15.6%) patients had diabetes. Patients with diabetes had a higher cardiovascular risk profile and worse kidney function. The occurrence of the primary end point was similar between patients with and without diabetes (HR, 1.14 (95% CI, 0.69-1.90), p-value = 0.60). Rates of non-cardiovascular death (HR, 6.53 (95% CI, 2.00-21.33)) and acute renal failure (HR, 3.23 (95% CI, 1.49-7.04)) were higher in diabetic patients as compared to non-diabetic patients. Comparing an immediate with a staged PCI strategy in diabetic patients, a numerically lower number of patients in the immediate PCI group experienced a primary end point event (10.6% vs. 16.9%, HR, 0.60 (95% CI, 0.23-1.53), p-value = 0.28).
Among diabetic patients with STEMI and MVD, a strategy of immediate multivessel PCI may be safe and comparable to a strategy of staged multivessel PCI.
Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.
与非糖尿病患者相比，患有ST段抬高型心肌梗死（STEMI）的糖尿病患者发生心血管事件的风险更高。本分析在一项当代试验中调查了患有多支血管病变（MVD）和STEMI的糖尿病患者的预后，以及在这一高危人群中即刻与分期多支血管PCI策略的相关性。
将纳入多支血管急性心肌梗死（MULTISTARS AMI）试验的患者根据是否患有糖尿病进行分层。比较糖尿病患者和非糖尿病患者的基线特征及预后。主要终点是1年时全因死亡、非致命性心肌梗死、中风、非计划性缺血驱动的血运重建或因心力衰竭住院的复合终点。
在MULTISTARS AMI试验的840例患者中，131例（15.6%）患有糖尿病。糖尿病患者具有更高的心血管风险特征和更差的肾功能。有糖尿病和无糖尿病患者的主要终点发生率相似（HR，1.14（95%CI，0.69-1.90），p值=0.60）。与非糖尿病患者相比，糖尿病患者的非心血管死亡（HR，6.53（95%CI，2.00-21.33））和急性肾衰竭（HR，3.23（95%CI，1.49-7.04））发生率更高。在糖尿病患者中比较即刻PCI策略与分期PCI策略，即刻PCI组发生主要终点事件的患者数量在数值上较少（10.6%对16.9%，HR，0.60（95%CI，0.23-1.53），p值=0.28）。
在患有STEMI和MVD 的糖尿病患者中，即刻多支血管PCI策略可能是安全的，且与分期多支血管PCI策略相当。
由波士顿科学公司支持；MULTISTARS AMI，ClinicalTrials.gov编号，NCT031
