Impact of diabetes on outcomes of patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease undergoing percutaneous coronary intervention
Year: 2025
Type: article
Abstract: BACKGROUND: Diabetic patients with ST-segment elevation myocardial infarction (STEMI) are at an increased risk of cardiovascular events as compared to non-diabetic patients. This analysis investigated outcomes of diabetic patients presenting with multivessel disease (MVD) and STEMI in a contemporary trial and the relevance of an immediate versus staged multivessel PCI strategy in this high-risk population. METHODS: Patients enrolled in the MULTISTARS AMI trial were stratified according to the presence/absence of diabetes. Baseline characteristics and outcomes of diabetic and non-diabetic patients were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. RESULTS: In the MULTISTARS AMI trial, out of a total of 840 patients, 131 (15.6%) patients had diabetes. Patients with diabetes had a higher cardiovascular risk profile and worse kidney function. The occurrence of the primary end point was similar between patients with and without diabetes (HR, 1.14 (95% CI, 0.69-1.90), p-value = 0.60). Rates of non-cardiovascular death (HR, 6.53 (95% CI, 2.00-21.33)) and acute renal failure (HR, 3.23 (95% CI, 1.49-7.04)) were higher in diabetic patients as compared to non-diabetic patients. Comparing an immediate with a staged PCI strategy in diabetic patients, a numerically lower number of patients in the immediate PCI group experienced a primary end point event (10.6% vs. 16.9%, HR, 0.60 (95% CI, 0.23-1.53), p-value = 0.28). CONCLUSION: Among diabetic patients with STEMI and MVD, a strategy of immediate multivessel PCI may be safe and comparable to a strategy of staged multivessel PCI. TRIAL REGISTRATION: Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.
Source: Clinical Research in Cardiology
Authors: Philipp Jakob, Ferdinando Varbella, Axel Linke, Bettina Schwarz, Stephan B. Felix, Moritz Seiffert, Rahel Kesterke, Peter Nordbeck, Bernhard Witzenbichler, Irene M. Lang, Mirjam Kessler, Christian Valina, Alban Dibra, Miklos Rohla, Marco Moccetti, Matteo Vercellino, Luise Gaede, Lorenz Bott-Flügel, Julia Stehli, Alessandro Candreva, Francesco Paneni, Christian Templin, Matthias Schindler, Manfred Wischnewsky, Greca Zanda, Giorgio Quadri, Norman Mangner, Aurel Toma, Giulia Magnani, Peter Clemmensen, Thomas F. Lüscher, Thomas Münzel, P. Christian Schulze, Karl-Ludwig Laugwitz, Wolfgang Rottbauer, Kurt Huber, Franz-Josef Neumann, Steffen Schneider, Thomas Riemer, Franz Weidinger, Stephan Achenbach, Gert Richardt, Adnan Kastrati, Ian Ford, Frank Ruschitzka, Barbara E. Stähli, for the MULTISTARS A. M. I. Investigators
Institutions: University of Zurich, University Hospital Zurich, Ospedale degli Infermi, Herzzentrum Dresden Universitätsklinik, Technische Universität Dresden, Segeberger Kliniken, Universitätsmedizin Greifswald, Universität Greifswald, German Centre for Cardiovascular Research, BG University Hospital Bergmannsheil Bochum, Ruhr University Bochum, Universitätsklinikum Würzburg, Helios Amper-Klinikum Dachau, Medical University of Vienna, Universität Ulm, University of Freiburg, University Medical Center Freiburg, University of Medicine Tirana, Mother Teresa Hospital, Sigmund Freud Privatuniversität Wien, University of Bern, University Hospital of Bern, Wilhelminen Hospital, Ente Ospedaliero Cantonale, Istituto Cardiocentro Ticino, Azienda Ospedaliera Nazionale SS. Antonio e Biagio e Cesare Arrigo, Friedrich-Alexander-Universität Erlangen-Nürnberg, University of Bremen, University of Parma, Ospedale di Parma, Universität Hamburg, University Medical Center Hamburg-Eppendorf, Harefield Hospital, Imperial College London, Johannes Gutenberg University Mainz, University Medical Center of the Johannes Gutenberg University Mainz, Jena University Hospital, Friedrich Schiller University Jena, TUM Klinikum, Technical University of Munich, Stiftung Institut für Herzinfarktforschung, Deutsches Herzzentrum München, University of Glasgow
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,190
Award: G5083541720
OpenAlex ID: W4414085251