Virtual Conference
Heart 2022 Conference

Rebeca Mata Caballero

Hospital Universitario de Getafe , Spain

Title: Revascularization in diabetic patients with acute myocardial infarction: real-world experience

Abstract

Background: Current evidence continues to favour coronary surgical revascularization (CABG) as the revascularization modality of choice for most of patients with ischemic heart disease and diabetes mellitus. However, the availability of each technique, the need for urgent revascularization and the less invasive nature of percutaneous coronary intervention (PCI) influence the clinician's decision. The aim of this study is to characterize the real-world clinical and angiographic profile of diabetic patients revascularized by PCI or bypass and to study their evolution.

Methods: An observational, prospective, analytical study was developed in a University Hospital, with a median follow up of 37 months [RIC 19-55]. The decision of the method of revascularization in this setting (acute coronary syndrome) was made by the clinical cardiologist, based on the recommendations of the ESC guidelines, taking into account the patient's preferences and the results of each technique in our Hospital.

Results: We included 236 patients with diabetes mellitus disease (DM) and significant coronary artery obstruction, of whom 213 (90%) were revascularized by PCI and 22 (10%) by surgery. There were no significant differences in the clinic profile of the patients in both groups, except for the mean age of the patients who underwent CABG, which was significantly lower than in those who underwent PCI (73±18 vs 66±12 years, p=0.02), with a higher proportion of smokers (84% vs 70%, p=0.034). Significant differences were observed in the ECG repolarization alterations during infarction. Higher percentage of patients undergoing PCI presented ST elevation (38% vs 14%), which in most cases requires emergent revascularization, than in patients undergoing CABG, in whom the procedure can usually be performed deferred, with a higher proportion of patients with ST-segment depression (50% vs 14%) in this group. There were longer admissions in patients who underwent CABG vs PCI (14±6 days vs 5±3 days).

The extent of coronary artery disease was different in both groups (p<0.01). Patients undergoing PCI had less extended and severe coronary disease: one vessel (44%), 2 vessels (31%), 3 vessels (19%), left main coronary artery + left anterior descending artery (4%) and left main coronary artery + right coronary artery (9%); compared to CABG patients with: 0%, 14%, 55%, 23%, and 9% respectively. Long-term evolution was similar in terms of mortality (22% vs 21%), reinfarction (5% vs 4%), and stroke  incidence, however, a lower rate of readmission was shown in CABG patients (26% vs 34%).

Conclusion: Despite current recommendations, percutaneous coronary revascularization was the technique most commonly performed in diabetic patients in the setting of acute myocardial infarction. Surgical patients were younger with greater extension and severity of coronary disease, despite which the long-term results were similar to those who underwent PCI.

Biography

Professor at Universidad Europea de Madrid/Doctor Cardiology at Hospital Universitario de Getafe, Spain