Long-term impact of diabetes in patients with ST-segment elevation myocardial infarction: Insights from the EXAMINATION randomized trial
Corresponding Author
Pilar Jimenez-Quevedo MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Correspondence
Pilar Jimenez-Quevedo, MD, PhD, Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, c/Martín Lagos s/n, 28040 Madrid, Spain.
Email: [email protected]
Search for more papers by this authorSalvatore Brugaletta MD, PhD
Interventional Cardiology Department, University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorAngel Cequier MD, PhD
Interventional Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain
Search for more papers by this authorAndrés Iñiguez MD, PhD
Interventional Cardiology Department, Hospital do Meixoeiro, Vigo, Spain
Search for more papers by this authorAntonio Serra MD, PhD
Interventional Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain
Search for more papers by this authorVicente Mainar MD, PhD
Interventional Cardiology Department, Hospital General of Alicante, Alicante, Spain
Search for more papers by this authorGianluca Campo MD, PhD
Interventional Cardiology Department, University Hospital Ferrara, Ferrara, Italy
Search for more papers by this authorMaurizio Tespili MD, PhD
Interventional Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy
Search for more papers by this authorLuis Nombela-Franco MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorMaria del Trigo MD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorNieves Gonzalo MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorJavier Escaned MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorPablo Salinas MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorIvan Nuñez-Gil MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorCristina Fernandez-Perez MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorAntonio Fernández-Ortiz MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorCarlos Macaya MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorPatrick W. Serruys MD, PhD
Interventional Cardiology Department, International Centre of Circulatory Health, Imperial College London, London, United Kingdom
Search for more papers by this authorManel Sabate Tenas MD, PhD
Interventional Cardiology Department, University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorCorresponding Author
Pilar Jimenez-Quevedo MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Correspondence
Pilar Jimenez-Quevedo, MD, PhD, Interventional Cardiology Department, Hospital Clinico San Carlos, IdISSC, c/Martín Lagos s/n, 28040 Madrid, Spain.
Email: [email protected]
Search for more papers by this authorSalvatore Brugaletta MD, PhD
Interventional Cardiology Department, University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorAngel Cequier MD, PhD
Interventional Cardiology Department, University Hospital of Bellvitge, Barcelona, Spain
Search for more papers by this authorAndrés Iñiguez MD, PhD
Interventional Cardiology Department, Hospital do Meixoeiro, Vigo, Spain
Search for more papers by this authorAntonio Serra MD, PhD
Interventional Cardiology Department, University Hospital of Sant Pau, Barcelona, Spain
Search for more papers by this authorVicente Mainar MD, PhD
Interventional Cardiology Department, Hospital General of Alicante, Alicante, Spain
Search for more papers by this authorGianluca Campo MD, PhD
Interventional Cardiology Department, University Hospital Ferrara, Ferrara, Italy
Search for more papers by this authorMaurizio Tespili MD, PhD
Interventional Cardiology Department, University Hospital Bolognini Seriate, Bergamo, Italy
Search for more papers by this authorLuis Nombela-Franco MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorMaria del Trigo MD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorNieves Gonzalo MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorJavier Escaned MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorPablo Salinas MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorIvan Nuñez-Gil MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorCristina Fernandez-Perez MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorAntonio Fernández-Ortiz MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorCarlos Macaya MD, PhD
Interventional Cardiology Department, Clinico San Carlos University Hospital, IdISSC, Madrid, Spain
Search for more papers by this authorPatrick W. Serruys MD, PhD
Interventional Cardiology Department, International Centre of Circulatory Health, Imperial College London, London, United Kingdom
Search for more papers by this authorManel Sabate Tenas MD, PhD
Interventional Cardiology Department, University Hospital Clínic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
Search for more papers by this authorFunding information Spanish Heart Foundation
Abstract
Background
Long-term outcomes of diabetic patients suffering from ST-segment elevation myocardial infarction (STEMI) and treated with second-generation drug-eluting stent have been scarcely evaluated. The aim of this posthoc subanalysis of the EXAMINATION trial was to compare 5-year outcomes according to the presence of diabetes mellitus.
Methods
From a total of 1,497 patients included in the trial, 258 were diabetics (n = 137, received everolimus-eluting stent (EES) and n = 121 bare-metal stent (BMS); whereas 1,239 were nondiabetics (n = 613 treated with EES and n = 626 with BMS). Patient-oriented combined endpoint (POCE) defined as all-cause death, any MI or any revascularization, and other clinical parameters were collected up to 5-years. All results were adjusted for various potential confounders.
Results
At 5-years, patients with diabetes showed similar rates of POCE between diabetics treated with EES and those treated with BMS (32.8% vs. 32.2%; p = 0.88). However, rates of TLR were significantly lower in the EES group (4.4% vs. 9.9%; HR 0.52 (0.29–0.94); P = 0.03). In non-diabetics, the use of EES was associated with a significant improvement in all-clinical parameters except for MI rate: POCE: [10.0% vs. 12.6%; HR 0.78(0.62–0.98); P = 0.038], all cause death: [7.0% vs. 12.1%; HR 0.62(0.42–0.90); P = 0.014], and [TLR: 4.2 vs. 6.7; HR 0.60 (0.37–0.98); P = 0.04]. Overall, diabetics showed higher rate of POCE at 5-years (32.6% vs. 21.5% in nondiabetics HR1.45[1.03–2.04];p = 0.03) driven by increased rates of MI and the need for revascularization that occurred in coronary segments remote from target lesions [2.7% vs. 1.1%; HR: 2.27 (1.12–5.23); P = 0.02 and 14% vs. 6.2%; HR: 2.11 (1.38–3.22); P = 0.001, respectively].
Conclusions
Diabetics had worse clinical outcomes than nondiabetics after STEMI mainly due to atherosclerosis progression. At 5-years, the treatment with EES did not reduce the rate of POCE in diabetics but reduced the need for revascularization compared with BMS.
Supporting Information
| Filename | Description |
|---|---|
| ccd28194-sup-0001-Table.docxWord 2007 document , 76.1 KB | Table S1 |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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