Comparison of Clinical Outcomes of Primary Percutaneous Interventions in Acute Myocardial Infarction among Diabetic Versus Non-Diabetic Patients with Particular Reference to MACCE Outcomes: A Cross-Sectional Comparative Study

Abstract

Background: Over 30 years, the improving outcomes in patients with diabetes who underwent PCIs have been similar to improvements in patients without diabetes mellitus (DM). Importantly, the risk-adjusted association of DM with long-term death, myocardial infarction, and stroke has decreased in the current era. The present study was undertaken with an aim to compare the clinical outcomes post primary percutaneous coronary interventions (PCI) in diabetics and non-diabetics.

Material and Methods: The present study was conducted among 105 patients with Acute ST elevation myocardial infarction (STEMI) and who underwent PCI, during the period April 2016 to May 2017, as a cross-sectional comparative study. These patients were followed up for primary clinical Major Adverse Cardiac and Cerebral event (MACCE) and repeat hospitalization for clinically significant angina or heart failure up to 6 months from the date of inclusion in the study at regular intervals: at discharge, at one-month, and at 6-month follow-ups. Difference in proportions and means were tested for statistical significance by chi square test and independent sample t test respectively.

Results: Most non-diabetic patients were concentrated in the 51–60 years age group, with 32% (n=16) of diabetic patients and 43.64% (n=24) of non-diabetic patients falling within this range. At the end of six months, the risk of major adverse cardiovascular and cerebrovascular events (MACCE) was significantly higher—3.04 times greater—in diabetic patients with hypertension as a comorbidity compared to non-diabetic patients (p = 0.014). Furthermore, among those presenting to the hospital within 180 minutes of symptom onset, diabetic patients exhibited a 4.54-fold significantly higher risk of MACCE than non-diabetic individuals (p = 0.041).

Conclusion: Primary PCI treatment option in diabetics is non-inferior to primary PCI in non-diabetics when comparing MACCE outcomes, secondary heart failure, deaths or angina admissions in 6-month follow-up period. PCI complication rates are comparable between the diabetic and the non-diabetic groups.