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Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial.

Publication ,  Journal Article
Timmer, JR; Ottervanger, JP; de Boer, M-J; Boersma, E; Grines, CL; Westerhout, CM; Simes, RJ; Granger, CB; Zijlstra, F ...
Published in: Arch Intern Med
July 9, 2007

BACKGROUND: There is growing evidence for a clinical benefit of primary percutaneous coronary intervention (PCI) compared with fibrinolysis; however, whether the treatment effect is consistent among patients with diabetes mellitus is unclear. We compared PCI with fibrinolysis for treatment of ST-segment elevation myocardial infarction in patients with diabetes mellitus. METHODS: A pooled analysis of individual patient data from 19 trials comparing primary PCI with fibrinolysis for treatment of ST-segment elevation myocardial infarction was performed. Trials that enrolled at least 50 patients with ST-segment elevation myocardial infarction and randomized patients to receive either primary PCI or fibrinolysis were considered for inclusion in our study. Clinical end points were total deaths, recurrent infarction, death or nonfatal recurrent infarction, and stroke, measured 30 days after randomization. RESULTS: Of 6315 patients, 877 (14%) had diabetes. Thirty-day mortality (9.4% vs 5.9%; P < .001) was higher in patients with diabetes. Mortality was lower after primary PCI compared with fibrinolysis in both patients with diabetes (unadjusted odds ratio, 0.49; 95% confidence interval, 0.31-0.79; P = .004) and without diabetes (unadjusted odds ratio, 0.69; 95% confidence interval, 0.54-0.86, P = .001), with no evidence of heterogeneity of treatment effect (P = .24 for interaction). Recurrent infarction and stroke were also reduced after primary PCI in both patient groups. After multivariable analysis, primary PCI was associated with decreased 30-day mortality in patients with and without diabetes, with a point estimate of greater benefit in diabetic patients. CONCLUSIONS: Diabetic patients with ST-segment elevation myocardial infarction treated with reperfusion therapy have increased mortality compared with patients without diabetes. The beneficial effects of primary PCI compared with fibrinolysis in diabetic patients are consistent with effects in nondiabetic patients.

Duke Scholars

Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

July 9, 2007

Volume

167

Issue

13

Start / End Page

1353 / 1359

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Survival Analysis
  • Recurrence
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Timmer, J. R., Ottervanger, J. P., de Boer, M.-J., Boersma, E., Grines, C. L., Westerhout, C. M., … Primary Coronary Angioplasty vs Thrombolysis-2 Trialists Collaborators Group, . (2007). Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial. Arch Intern Med, 167(13), 1353–1359. https://doi.org/10.1001/archinte.167.13.1353
Timmer, Jorik R., Jan Paul Ottervanger, Menko-Jan de Boer, Eric Boersma, Cindy L. Grines, Cynthia M. Westerhout, R John Simes, Christopher B. Granger, Felix Zijlstra, and Felix Primary Coronary Angioplasty vs Thrombolysis-2 Trialists Collaborators Group. “Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial.Arch Intern Med 167, no. 13 (July 9, 2007): 1353–59. https://doi.org/10.1001/archinte.167.13.1353.
Timmer JR, Ottervanger JP, de Boer M-J, Boersma E, Grines CL, Westerhout CM, et al. Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial. Arch Intern Med. 2007 Jul 9;167(13):1353–9.
Timmer, Jorik R., et al. “Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial.Arch Intern Med, vol. 167, no. 13, July 2007, pp. 1353–59. Pubmed, doi:10.1001/archinte.167.13.1353.
Timmer JR, Ottervanger JP, de Boer M-J, Boersma E, Grines CL, Westerhout CM, Simes RJ, Granger CB, Zijlstra F, Primary Coronary Angioplasty vs Thrombolysis-2 Trialists Collaborators Group. Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial. Arch Intern Med. 2007 Jul 9;167(13):1353–1359.

Published In

Arch Intern Med

DOI

ISSN

0003-9926

Publication Date

July 9, 2007

Volume

167

Issue

13

Start / End Page

1353 / 1359

Location

United States

Related Subject Headings

  • Thrombolytic Therapy
  • Survival Analysis
  • Recurrence
  • Myocardial Infarction
  • Multivariate Analysis
  • Middle Aged
  • Male
  • Humans
  • General & Internal Medicine
  • Female