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Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb Angioplasty Substudy. Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes.

Publication ,  Journal Article
Hasdai, D; Granger, CB; Srivatsa, SS; Criger, DA; Ellis, SG; Califf, RM; Topol, EJ; Holmes, DR
Published in: J Am Coll Cardiol
May 2000

OBJECTIVES: We sought to compare the efficacy of primary angioplasty in diabetics versus nondiabetics and to evaluate the relative benefits of angioplasty over thrombolytic therapy among diabetics. BACKGROUND: Primary angioplasty for myocardial infarction is at least as effective as thrombolytic therapy in the general population. However, the influence of diabetic status on outcome after primary angioplasty versus thrombolysis remains unknown. METHODS: Patients in the Global Use of Strategies To Open Occluded Arteries in Acute Coronary Syndromes (GUSTO-IIb) Angioplasty Substudy were randomized to receive either primary angioplasty or accelerated alteplase. The interaction of diabetic status (diabetics n = 177, nondiabetics n = 961) and treatment strategy with the occurrence of the primary end point (death, nonfatal reinfarction or nonfatal, disabling stroke at 30 days) was analyzed (power to detect a 40% relative reduction in the primary end point with alpha = 0.05 and beta = 0.20). Among patients who were randomized to and underwent primary angioplasty, procedural success (defined as residual stenosis <50% and TIMI grade 3 flow) was assessed based on diabetic status. RESULTS: Compared with nondiabetics, diabetics had worse baseline clinical and angiographic profiles. Despite more severe stenosis and poorer flow in the culprit artery, procedural success with angioplasty was similar for diabetics (n = 81; 70.4%) and nondiabetics (n = 391; 72.4%). Outcome at 30 days was better for nondiabetics randomized to angioplasty versus alteplase (adjusted odds ratio, 0.62; 95% confidence interval, 0.41-0.96) with a similar trend for diabetics (0.70, [0.29-1.72]). We noted no interaction between diabetic status and treatment strategy on outcome (p = 0.88). CONCLUSIONS: Primary angioplasty was similarly successful in diabetics and nondiabetics and appeared to be more effective than thrombolytic therapy among diabetics with acute infarction.

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 2000

Volume

35

Issue

6

Start / End Page

1502 / 1512

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Rate
  • Recurrence
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Length of Stay
  • Humans
 

Citation

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Hasdai, D., Granger, C. B., Srivatsa, S. S., Criger, D. A., Ellis, S. G., Califf, R. M., … Holmes, D. R. (2000). Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb Angioplasty Substudy. Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes. J Am Coll Cardiol, 35(6), 1502–1512. https://doi.org/10.1016/s0735-1097(00)00591-x
Hasdai, D., C. B. Granger, S. S. Srivatsa, D. A. Criger, S. G. Ellis, R. M. Califf, E. J. Topol, and D. R. Holmes. “Diabetes mellitus and outcome after primary coronary angioplasty for acute myocardial infarction: lessons from the GUSTO-IIb Angioplasty Substudy. Global Use of Strategies to Open Occluded Arteries in Acute Coronary Syndromes.J Am Coll Cardiol 35, no. 6 (May 2000): 1502–12. https://doi.org/10.1016/s0735-1097(00)00591-x.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

May 2000

Volume

35

Issue

6

Start / End Page

1502 / 1512

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Survival Rate
  • Recurrence
  • Myocardial Infarction
  • Middle Aged
  • Male
  • Length of Stay
  • Humans