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Background <p>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.</p> Methods <p>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&#xa0;year.</p> Results <p>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), <i>p</i>-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), <i>p</i>-value = 0.28).</p> Conclusion <p>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.</p> Trial registration <p>Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.</p> Graphical Abstract <p></p>

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Impact of diabetes on outcomes of patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease undergoing percutaneous coronary intervention

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年9月10日

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  • 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

摘要

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.

Graphical Abstract