Pre-infarction angina is associated with improved prognosis in diabetic patients with ST-elevation myocardial infarction – data from a contemporary cohort
| Autor: | Sofia Cabral, Raquel Alves dos Santos, Severo Torres, Ricardo A. Costa, André Luz, João Silveira, Bruno Brochado, Mário Santos, Marta Fontes Oliveira, André Frias |
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| Rok vydání: | 2020 |
| Předmět: |
Male
medicine.medical_specialty Myocardial Ischemia Infarction 030204 cardiovascular system & hematology Coronary Angiography Chest pain Angina Pectoris Angina Electrocardiography 03 medical and health sciences 0302 clinical medicine Coronary Circulation Diabetes mellitus Internal medicine Diabetes Mellitus medicine Humans cardiovascular diseases 030212 general & internal medicine Myocardial infarction Angioplasty Balloon Coronary Ejection fraction Portugal biology business.industry Incidence Stroke Volume General Medicine Middle Aged Protective Factors Prognosis medicine.disease Survival Analysis Troponin Ischemic Preconditioning Myocardial biology.protein Cardiology ST Elevation Myocardial Infarction Female medicine.symptom Cardiology and Cardiovascular Medicine business Mace |
| Zdroj: | Coronary Artery Disease. 32:375-381 |
| ISSN: | 0954-6928 |
| DOI: | 10.1097/mca.0000000000000968 |
| Popis: | BACKGROUND Pre-infarction angina (PIA) is associated with improved prognosis in patients with ST-elevation myocardial infarction (STEMI). Some studies suggest that diabetes may blunt the effect of ischaemic preconditioning. We sought to study the impact of PIA in diabetic patients with STEMI. METHODS Consecutive patients with STEMI who underwent primary angioplasty were included. PIA was defined as ≥1 episode of chest pain during the week preceding STEMI diagnosis. Incident major adverse cardiovascular events (MACE) were defined as the first occurrence of all-cause death, stroke or acute myocardial infarction. RESULTS Of the 1143 included patients, 25% were diabetic and 32% had a history of PIA. Diabetic patients with PIA had smaller infarct sizes as estimated by peak creatine kinase (CK) [1144 (500-2212) vs. 1715 (908-3309) U/L, P = 0.003] and peak troponin [3.30 (1.90-6.58) vs. 4.88 (2.50-9.58) ng/ml, P = 0.002], compared to diabetics without PIA. They also had a lower likelihood of evolving with moderate to severe reduced left ventricle ejection fraction (LVEF) (25.6%, n = 22 vs. 46.6%, n = 82, P = 0.001). In non-diabetic patients, PIA was associated with reduced peak CK [1549 (909-2909) vs. 1793 (996-3078), P = 0.0497], but not troponin (3.74 [2.23-7.11] vs. 4.56 [2.44-7.77] ng/ml, P = 0.19), and was not associated with reduced LVEF (32.0%, n = 85 vs. 37.4%, n = 207, P = 0.13). Both diabetic and non-diabetic patients with PIA had a lower likelihood of evolving with a Killip class III/VI (non-diabetic patients: 5.6% vs. 14.1%, P = 0.002; diabetic patients: 12.8% vs. 24.6%, P = 0.049). Over a median follow-up of 18.0 (12.1-25.5) months, PIA was associated with a significant reduction in the incidence of MACE [hazard ratio 0.52, 95% confidence interval (CI) 0.37-0.74, P < 0.001], irrespective of diabetes status. CONCLUSION PIA is an independent predictor of favourable outcomes in the setting of STEMI for both diabetic and non-diabetic patients. |
| Databáze: | OpenAIRE |
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