Journal of Thrombosis and Thrombolysis

, Volume 30, Issue 2, pp 133–141 | Cite as

Impact of diabetes on long-term outcome in STEMI patients undergoing primary angioplasty with glycoprotein IIb–IIIa inhibitors and BMS or DES

  • Giuseppe De LucaEmail author
  • Rosario Sauro
  • Attilio Varricchio
  • Michele Capasso
  • Tonino Lanzillo
  • Fiore Manganelli
  • Ciro Mariello
  • Francesco Siano
  • Giannignazio Carbone
  • Maria Rosaria Pagliuca
  • Giuseppe Rosato
  • Emilio Di Lorenzo


Diabetes has been shown to be associated with worse survival and repeat revascularization (TVR) after primary angioplasty. Drug-eluting stent (DES) may offer benefits in terms of TVR, that may be counterbalanced by an higher risk of stent thrombosis, especially among STEMI patients. Aim of the current study was to evaluate the impact of diabetes on 5-year outcome in patients undergoing primary angioplasty with Glycoprotein IIb–IIIa inhibitors in the era of DES. Our population is represented by STEMI patients undergoing primary angioplasty and stent implantation at a tertiary center with 24-h primary PCI capability within 12 h of symptom onset. All patients received glycoprotein IIb–IIIa inhibitors. No patient was lost to follow up. From 2003 to 2005, 270 STEMI patients were treated with DES (n = 180), or BMS (n = 90). A total of 69 patients had history of diabetes at admission (25.5%). At a follow-up of 1510 ± 406 days, diabetes was associated with a higher rate of death (29.5 vs. 5.1%, P < 0.0001), reinfarction (24.1 vs. 9.1%, P < 0.0001), TVR (19.1 vs. 13.1%, P = 0.052), IST (17.2 vs. 6.8%, P < 0.001) and MACE (51.9 vs. 25.1%, P < 0.001). These results were confirmed in both patients receiving BMS or DES, except for TVR, where no difference was observed between diabetic and non-diabetic patients. This study shows that among STEMI patients undergoing primary angioplasty with Gp IIb–IIIa inhibitors, diabetes is associated with worse long-term mortality, reinfarction, and IST, even with DES implantation, that, however, were able to equalize the outcome in terms of TVR as compared to non diabetic patients.


Primary angioplasty Diabetes DES 


  1. 1.
    Keeley EC, Boura JA, Grines CL (2003) Primary angioplasty versus intravenous thrombolytic therapy for acute myocardial infarction: a quantitative review of 23 randomised trials. Lancet 361:13–20CrossRefPubMedGoogle Scholar
  2. 2.
    Stone GW, Grines CL, Cox DA, Garcia E, Tcheng JE, Griffin JJ, Guagliumi G, Stuckey T, Turco M, Carroll JD, Rutherford BD, Lansky AJ (2002) Controlled abciximab and device investigation to lower late angioplasty complications (CADILLAC) investigators. Comparison of angioplasty with stenting, with or without abciximab, in acute myocardial infarction. N Engl J Med 346:957–966CrossRefPubMedGoogle Scholar
  3. 3.
    De Luca G, Suryapranata H, Stone GW, Antoniucci D, Biondi-Zoccai G, Kastrati A, Chiariello M, Marino P (2008) Coronary stenting versus balloon angioplasty for acute myocardial infarction: a meta-regression analysis of randomized trials. Int J Cardiol 126:37–44CrossRefPubMedGoogle Scholar
  4. 4.
    Antoniucci D, Migliorini A, Parodi G, Valenti R, Rodriguez A, Hempel A, Memisha G, Santoro GM (2004) Abciximab-supported infarct artery stent implantation for acute myocardial infarction and long-term survival: a prospective, multicenter, randomized trial comparing infarct artery stenting plus abciximab with stenting alone. Circulation 109:1704–1706CrossRefPubMedGoogle Scholar
  5. 5.
    Suryapranata H, De Luca G, van’t Hof AW, Ottervanger JP, Hoorntje JC, Dambrink JH, Gosselink AT, Zijlstra F, de Boer MJ (2005) Is routine stenting for acute myocardial infarction superior to balloon angioplasty? A randomised comparison in a large cohort of unselected patients. Heart 91:641–645CrossRefPubMedGoogle Scholar
  6. 6.
    Elezi S, Kastrati A, Pache J, Wehinger A, Hadamitzky M, Dirschinger J, Neumann FJ, Schomig A (1998) Diabetes mellitus and the clinical and angiographic outcome after coronary stent placement. J Am Coll Cardiol 32:1866–1873CrossRefPubMedGoogle Scholar
  7. 7.
    Kornowski R, Mintz GS, Kent KM, Pichard AD, Satler LF, Bucher TA, Hong MK, Popma JJ, Leon MB (1997) Increased restenosis in diabetes mellitus after coronary interventions is due to exaggerated intimal hyperplasia: a serial intravascular ultrasound study. Circulation 95:1366–1369PubMedGoogle Scholar
  8. 8.
    Bolognese L, Carrabba N, Santoro GM, Valenti R, Buonamici P, Antoniucci D (2003) Angiographic findings, time course of regional and global left ventricular function, and clinical outcome in diabetic patients with acute myocardial infarction treated with primary percutaneous transluminal coronary angioplasty. Am J Cardiol 91:544–549CrossRefPubMedGoogle Scholar
  9. 9.
    Moses JW, Leon MB, Popma JJ, Fitzgerald PJ, Holmes DR, O’Shaughnessy C et al (2003) SIRIUS investigators. Sirolimus-eluting stents versus standard stents in patients with stenosis in a native coronary artery. N Engl J Med 349:1315–1323CrossRefPubMedGoogle Scholar
  10. 10.
    Stone GW, Ellis SG, Cox DA, Hermiller J, O’Shaughnessy C, Mann JT et al (2004) TAXUS-IV Investigators; TAXUS-IV Investigators. A polymer-based, paclitaxel-eluting stent in patients with coronary artery disease. N Engl J Med 350:221–231CrossRefPubMedGoogle Scholar
  11. 11.
    Ardissino D, Cavallini C, Bramucci E, Indolfi C, Marzocchi A, Manari A et al (2004) SES-SMART investigators. Sirolimus-eluting vs uncoated stents for prevention of restenosis in small coronary arteries: a randomized trial. JAMA 292:2727–2734CrossRefPubMedGoogle Scholar
  12. 12.
    Colombo A, Moses JW, Morice MC, Ludwig J, Holmes DR Jr, Spanos V et al (2004) Randomized study to evaluate sirolimus-eluting stents implanted at coronary bifurcation lesions. Circulation 109:1244–1249CrossRefPubMedGoogle Scholar
  13. 13.
    Roiron C, Sanchez P, Bouzamondo A, Lechat P, Montalescot G (2006) Drug eluting stents: an updated meta-analysis of randomised controlled trials. Heart 92:641–649CrossRefPubMedGoogle Scholar
  14. 14.
    Valgimigli M, Bolognese L, Anselmi M, Campo G, Rodriguez AE, de Cesare N et al (2005) Tirofiban and sirolimus-eluting stent vs. abciximab and bare-metal stent for acute myocardial infarction: a randomized trial. JAMA 293:2109–2117CrossRefPubMedGoogle Scholar
  15. 15.
    Spaulding C, Henry P, Teiger E, Beatt K, Bramucci E, Carrié D et al (2006) TYPHOON investigators. Sirolimus-eluting versus uncoated stents in acute myocardial infarction. N Engl J Med 355:1093–1104CrossRefPubMedGoogle Scholar
  16. 16.
    Menichelli M, Parma A, Pucci E, Fiorilli R, De Felice F, Nazzaro M et al (2007) Randomized trial of sirolimus-eluting stent versus bare-metal stent in acute myocardial infarction (SESAMI). J Am Coll Cardiol 49:1924–1930CrossRefPubMedGoogle Scholar
  17. 17.
    van der Hoeven BL, Liem SS, Jukema JW, Suraphakdee N, Putter H, Dijkstra J, Atsma DE, Bootsma M, Zeppenfeld K, Oemrawsingh PV, van der Wall EE, Schalij MJ (2008) Sirolimus-eluting stents versus bare-metal stents in patients with ST-segment elevation myocardial infarction: 9-month angiographic and intravascular ultrasound results and 12-month clinical outcome results from the MISSION! Intervention study. J Am Coll Cardiol 51:618–626CrossRefPubMedGoogle Scholar
  18. 18.
    Valgimigli M, Campo G, Percoco G, Bolognese L, Vassanelli C, Colangelo S, de Cesare N, Rodriguez AE, Ferrario M, Moreno R, Piva T, Sheiban I, Pasquetto G, Prati F, Nazzaro MS, Parrinello G, Ferrari R (2008) Multicentre evaluation of single high-dose bolus tirofiban vs abciximab with sirolimus-eluting stent or bare metal stent in acute myocardial infarction study (MULTISTRATEGY) investigators. Comparison of angioplasty with infusion of tirofiban or abciximab and with implantation of sirolimus-eluting or uncoated stents for acute myocardial infarction: the MULTISTRATEGY randomized trial. JAMA 299:1788–1799CrossRefPubMedGoogle Scholar
  19. 19.
    McFadden EP, Stabile E, Regar E, Cheneau E, Ong AT, Kinnaird T et al (2004) Late thrombosis in drug-eluting coronary stents after discontinuation of antiplatelet therapy. Lancet 364:1519–1521CrossRefPubMedGoogle Scholar
  20. 20.
    Iakovou I, Schmidt T, Bonizzoni E, Ge L, Sangiorgi GM, Stankovic G et al (2005) Incidence, predictors, and outcome of thrombosis after successful implantation of drug-eluting stents. JAMA 293:2126–2130CrossRefPubMedGoogle Scholar
  21. 21.
    Lagerqvist B, James SK, Stenestrand U, Lindbäck J, Nilsson T, Wallentin L, SCAAR Study Group (2007) Long-term outcomes with drug-eluting stents versus bare-metal stents in Sweden. N Engl J Med 356:1009–1019CrossRefPubMedGoogle Scholar
  22. 22.
    Kernis SJ, Cohen D, Rein K (2005) Clinical outcome associated with use of drug-eluting stents compared with bare metal stent for primary percutaneous intervention. Am J Cardiol 96(suppl 7A):47HGoogle Scholar
  23. 23.
    Spertus JA, Kettelkamp R, Vance C, Decker C, Jones PG, Rumsfeld JS et al (2006) Prevalence, predictors, and outcomes of premature discontinuation of thienopyridine therapy after drug-eluting stent placement: results from the PREMIER registry. Circulation 113:2803–2809CrossRefPubMedGoogle Scholar
  24. 24.
    Di Lorenzo E, De Luca G, Sauro R et al (2009) PaclitAxel or Sirolimus-Eluting Stent vs Bare Metal Stent in primary angioplasty (PASEO) randomized trial. JACC Cardiovasc Interv 2:515–523CrossRefPubMedGoogle Scholar
  25. 25.
    Di Lorenzo E, Sauro R, Varricchio A et al (2009) Long-term outcome of drug-eluting stents compared with bare metal stents in ST-segment elevation myocardial infarction: results of the paclitaxel- or sirolimus-eluting stent versus bare metal stent in Primary Angioplasty (PASEO) randomized trial. Circulation 120:964–972CrossRefPubMedGoogle Scholar
  26. 26.
    Capes SE, Hunt D, Malmberg K, Gerstein HC (2000) Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet 355:773–778CrossRefPubMedGoogle Scholar
  27. 27.
    Bolk J, van der Ploeg T, Cornel JH, Arnold AE, Sepers J, Umans VA (2001) Impaired glucose metabolism predicts mortality after a myocardial infarction. Int J Cardiol 79:207–214CrossRefPubMedGoogle Scholar
  28. 28.
    Porter A, Assali AR, Zahalka A, Iakobishvili Z, Brosh D, Lev EI, Mager A, Battler A, Kornowski R, Hasdai D (2008) Impaired fasting glucose and outcomes of ST-elevation acute coronary syndrome treated with primary percutaneous intervention among patients without previously known diabetes mellitus. Am Heart J 155(2):284–289Google Scholar
  29. 29.
    Marso SP, Miller T, Rutherford BD, Gibbons RJ, Qureshi M, Kalynych A, Turco M, Schultheiss HP, Mehran R, Krucoff MW, Lansky AJ, Stone GW (2007) Comparison of myocardial reperfusion in patients undergoing percutaneous coronary intervention in ST-segment elevation acute myocardial infarction with versus without diabetes mellitus (from the EMERALD Trial). Am J Cardiol 100(2):206–210Google Scholar
  30. 30.
    Ishihara M, Kagawa E, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nakama Y, Maruhashi T, Ookawa K, Dai K, Aokage Y (2007) Impact of admission hyperglycemia and diabetes mellitus on short- and long-term mortality after acute myocardial infarction in the coronary intervention era. Am J Cardiol 99(12):1674–1679CrossRefPubMedGoogle Scholar
  31. 31.
    Timmer JR, van der Horst IC, de Luca G, Ottervanger JP, Hoorntje JC, de Boer MJ, Suryapranata H, Dambrink JH, Gosselink M, Zijlstra F, van’t Hof AW, Zwolle Myocardial Infarction Study Group (2005) Comparison of myocardial perfusion after successful primary percutaneous coronary intervention in patients with ST-elevation myocardial infarction with versus without diabetes mellitus. Am J Cardiol 95(11):1375–1377CrossRefPubMedGoogle Scholar
  32. 32.
    Marfella R, Esposito K, Giunta R, Coppola G, De Angelis L, Farzati B, Paolisso G, Giugliano D (2000) Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia. Circulation 101:2247–2251PubMedGoogle Scholar
  33. 33.
    Booth G, Stalker TJ, Lefer AM, Scalia R (2001) Elevated ambient glucose induces acute inflammatory events in the microvasculature: effects of insulin. Am J Physiol Endocrinol Metab 280:E848–E856PubMedGoogle Scholar
  34. 34.
    Hokama JY, Ritter LS, Davis-Gorman G, Cimetta AD, Copeland JG, McDonagh PF (2000) Diabetes enhances leukocyte accumulation in the coronary microcirculation early in reperfusion following ischemia. J Diabetes Complications 14:96–107CrossRefPubMedGoogle Scholar
  35. 35.
    Engler RL, Dahlgren MD, Morris DD, Peterson MA, Schmid-Schonbein GW (1986) Role of leukocytes in response to acute myocardial ischemia and reflow in dogs. Am J Physiol 251:H314–H323PubMedGoogle Scholar
  36. 36.
    Shechter M, Merz CN, Paul-Labrador MJ, Kaul S (2000) Blood glucose and platelet-dependent thrombosis in patients with coronary artery disease. J Am Coll Cardiol 35:300–307CrossRefPubMedGoogle Scholar
  37. 37.
    Sakuma T, Leong-Poi H, Fisher NG, Goodman NC, Kaul S (2003) Further insights into the no-reflow phenomenon after primary angioplasty in acute myocardial infarction: the role of microthromboemboli. J Am Soc Echocardiogr 16:15–21CrossRefPubMedGoogle Scholar
  38. 38.
    Nitenberg A, Valensi P, Sachs R, Dali M, Aptecar E, Attali J-R (1993) Impairment of coronary vascular reserve and ACh-induced coronary vasodilation in diabetic patients with angiographically normal coronary arteries and normal left ventricular systolic function. Diabetes 42:1017–1025CrossRefPubMedGoogle Scholar
  39. 39.
    Nahser PJ Jr, Brown RE, Oskarsson H, Winniford MD, Rossen JD (1995) Maximal coronary flow reserve and metabolic coronary vasodilation in patients with diabetes mellitus. Circulation 91:635–640PubMedGoogle Scholar
  40. 40.
    Ishihara M, Inoue I, Kawagoe T, Shimatani Y, Kurisu S, Nishioka K, Kouno Y, Umemura T, Nakamura S, Sato H (2001) Diabetes mellitus prevents ischemic preconditioning in patients with a first acute anterior wall myocardial infarction. J Am Coll Cardiol 38:1007–1011CrossRefPubMedGoogle Scholar
  41. 41.
    De Luca G, Michael Gibson C, Bellandi F, Murphy S, Maioli M, Noc M, Zeymer U, Dudek D, Arntz HR, Zorman S, Gabriel HM, Emre A, Cutlip D, Rakowski T, Gyongyosi M, Huber K, Van’t Hof AW (2009) Benefits of pharmacological facilitation with glycoprotein IIb-IIIa inhibitors in diabetic patients undergoing primary angioplasty for STEMI. A subanalysis of the EGYPT cooperation. J Thromb Thrombolysis 28(3):288–298Google Scholar
  42. 42.
    De Luca G, Suryapranata H, Timmer J, Ottervanger JP, van’t Hof AW, Hoorntje JC, Dambrink JH, Gosselink AT, de Boer MJ (2006) Impact of routine stenting on clinical outcome in diabetic patients undergoing primary angioplasty for ST-segment elevation myocardial infarction. Diabetes Care 29:920–923CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Giuseppe De Luca
    • 1
    • 2
    Email author
  • Rosario Sauro
    • 3
  • Attilio Varricchio
    • 3
  • Michele Capasso
    • 3
  • Tonino Lanzillo
    • 3
  • Fiore Manganelli
    • 3
  • Ciro Mariello
    • 3
  • Francesco Siano
    • 3
  • Giannignazio Carbone
    • 3
  • Maria Rosaria Pagliuca
    • 3
  • Giuseppe Rosato
    • 3
  • Emilio Di Lorenzo
    • 3
  1. 1.Division of Cardiology, Ospedale “Maggiore della Carità”Eastern Piedmont UniversityNovaraItaly
  2. 2.Centro di Biotecnologie per la Ricerca Medica Applicata (BRMA)Eastern Piedmont UniversityNovaraItaly
  3. 3.Division of Cardiology“S.G. Moscati”AvellinoItaly

Personalised recommendations