Research Article
Volume 7 Issue 7 - 2020
Long-term Outcomes of Patients with Diabetes Mellitus Undergoing Coronary Revascularization for ST-Segment Elevation Myocardial Infarction: A Single Centre Study
Shanathan Sritharan1, Alexander Dashwood2, Nathaniel Smilowitz3 and Seshasayee Narasimhan1,2,4,5*
1Divison of Cardiovascular Medicine, Manning Base Hospital, Taree, Australia
2Division of Cardiovascular Medicine, Gold Coast University Hospital, Southport, Australia
3Division of Cardiology, NYU School of Medicine, NY, USA
4School of Medicine and Public Health, University of Newcastle, Callaghan, Australia
5School of Rural Medicine, University of New England, Armidale, Australia
*Corresponding Author: Seshasayee Narasimhan, Divison of Cardiovascular Medicine, Manning Base Hospital, Taree, Australia.
Received: May 28, 2020; Published: June 22, 2020


Diabetes mellitus (DM) is a major risk factor for coronary artery disease (CAD) and is associated with a higher incidence of myocardial infarction (MI) and sudden cardiac death (SCD). Patients with DM have higher mortality during the acute period of acute coronary syndrome (ACS), greater morbidity during the postinfarction recovery phase and more frequent re-infarction than patients without DM. Reperfusion therapy with primary percutaneous coronary intervention (PCI) in ST-segment elevation myocardial infarction (STEMI) is associated with higher short-term mortality (30-days) in patients with DM when compared with outcomes in patients without DM. The long-term efficacy of reperfusion therapy with thrombolysis is well established, 8,9 but few data are available on long-term outcomes of PCI for STEMI in patients with DM. We therefore sought to determine long-term outcomes of contemporary PCI in STEMI patients with and without DM.

In a single centre series of 273 patients treated for STEMI in the contemporary era, 17.6% of patients had a diagnosis of DM.  Mortality was not different among patients with and without DM at all time points, although the proportion of deaths was numerically greater in DM patients.  Management of STEMI in patients with DM was associated with a trend more frequent AKI. Kidney injury is a significant risk factor for long-term mortality, highlighting the importance of mitigating AKI in patients with DM who present with STEMI.

In the present study, mortality at 3 years after STEMI in patients with DM was 18.9%. There was a trend toward adverse outcomes in patients with STEMI and DM compared to patients without DM, although due to the small sample size, none of the comparisons met statistical significance. Additional studies to improve outcomes of patients with DM and STEMI are necessary.

Keywords: Diabetes Mellitus; Revascularization; AKI


  1. Kannel WB and McGee DL. “Diabetes and cardiovascular disease. The Framingham study”. The Journal of the American Medical Association 241 (1979): 2035-2038.
  2. Fuller JH., et al. “Mortality from coronary heart disease and stroke in relation to degree of glycaemia: the Whitehall study”. British Medical Journal 287 (1983): 867-870.
  3. Haffner SM. “Coronary heart disease in patients with diabetes”. The New England Journal of Medicine 342 (2000): 1040-1042.
  4. Jacoby R and Nesto R. “Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis”. Journal of the American College of Cardiology 20 (1992):736-744.
  5. Aronson D., et al. “Mechanisms determining course and outcome of diabetic patients who have had acute myocardial infarction”. Annals of Internal Medicine 126 (1997): 296-306.
  6. Lee KL., et al. “Predictors of 30-day mortality in the era of reperfusion for acute myocardial infarction. Results from an international trial of 41,021 patients. GUSTO-I Investigators”. Circulation 91 (1995): 1659-1668.
  7. Abbott RD., et al. “The impact of diabetes on survival following myocardial infarction in men vs women. The Framingham Study”. The Journal of the American Medical Association 260 (1988): 3456-3460.
  8. Granger CB., et al. “Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) Study Group”. Journal of the American College of Cardiology 21 (1993): 920-925.
  9. Mak KH., et al. “Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries”. Journal of the American College of Cardiology 30 (1997): 171-179.
  10. BARI investigators. “Influence of diabetes on 5-year mortality and morbidity in a randomized trial comparing CABG and PTCA in patients with multivessel disease”. Circulation 96 (1997): 1761-1769.
  11. Kleiman N., et al. “Diabetes mellitus, glycoprotein IIb/IIIa blockade, and heparin: evidence for a complex interaction in a multicenter trial”. Circulation 97 (1998):1912-1920.
  12. Stein B., et al. “Influence of diabetes mellitus on early and late outcome after percutaneous transluminal coronary angioplasty”. Circulation 91 (1995): 979-989.
  13. Levine G., et al. “Impact of diabetes mellitus on percutaneous revascularization (CAVEAT-1)”. The American Journal of Cardiology 79 (1997): 748-755.
  14. Rihal C., et al. “Incidence and prognostic importance of acute renal failure after percutaneous coronary intervention”. Circulation 105 (2002): 22591-22664.
  15. Ghali WA., et al. “Comparison of 2 methods for calculating adjusted survival curves from proportional hazards models”. The Journal of the American Medical Association 286 (2001): 1494-1497.
  16. Mehran R., et al. “A simple risk score for prediction of contrast-induced nephropathy after percutaneous coronary intervention”. Journal of the American College of Cardiology 44 (2004): 1393-1399.
  17. Bartorelli AL and Marenzi G. “Contrast-Induced Nephropathy”. Journal of Interventional Cardiology 1 (2008): 74-85.
  18. Hung YM., et al. “Preventing radiocontrast-induced nephropathy in chronic kidney disease patients undergoing coronary angiography”. World Journal of Cardiology 5 (2012): 157-172.
  19. Gupta R., et al. “The renal patient with coronary artery disease: current concepts and dilemmas”. Journal of the American College of Cardiology 44 (2004): 1343-1353.
  20. Nash K., et al. “Hospital-acquired renal insufficiency”. The American Journal of Kidney Diseases 39 (2002): 930-936.
  21. James MT., et al. “Associations Between Acute Kidney Injury and Cardiovascular and Renal Outcomes After Coronary Angiography”. Circulation 123 (2011): 409-416.
  22. Jensen LO., et al. “Influence of Diabetes Mellitus on Clinical Outcomes Following Primary Percutaneous Coronary Intervention in Patients With ST-Segment Elevation Myocardial Infarction”. The American Journal of Cardiology 109 (2012): 629-635.
  23. Norhammar A., et al. “Long-term mortality after PCI in patients with diabetes mellitus: results from the Swedish Coronary Angiography and Angioplasty Registry”. EuroIntervention 8 (2010): 891-897.
Citation: Seshasayee Narasimhan., et al. “Long-term Outcomes of Patients with Diabetes Mellitus Undergoing Coronary Revascularization for ST-Segment Elevation Myocardial Infarction: A Single Centre Study”. EC Cardiology 7.7 (2020): 08-15.

PubMed Indexed Article

EC Pharmacology and Toxicology
LC-UV-MS and MS/MS Characterize Glutathione Reactivity with Different Isomers (2,2' and 2,4' vs. 4,4') of Methylene Diphenyl-Diisocyanate.

PMID: 31143884 [PubMed]

PMCID: PMC6536005

EC Pharmacology and Toxicology
Alzheimer's Pathogenesis, Metal-Mediated Redox Stress, and Potential Nanotheranostics.

PMID: 31565701 [PubMed]

PMCID: PMC6764777

EC Neurology
Differences in Rate of Cognitive Decline and Caregiver Burden between Alzheimer's Disease and Vascular Dementia: a Retrospective Study.

PMID: 27747317 [PubMed]

PMCID: PMC5065347

EC Pharmacology and Toxicology
Will Blockchain Technology Transform Healthcare and Biomedical Sciences?

PMID: 31460519 [PubMed]

PMCID: PMC6711478

EC Pharmacology and Toxicology
Is it a Prime Time for AI-powered Virtual Drug Screening?

PMID: 30215059 [PubMed]

PMCID: PMC6133253

EC Psychology and Psychiatry
Analysis of Evidence for the Combination of Pro-dopamine Regulator (KB220PAM) and Naltrexone to Prevent Opioid Use Disorder Relapse.

PMID: 30417173 [PubMed]

PMCID: PMC6226033

EC Anaesthesia
Arrest Under Anesthesia - What was the Culprit? A Case Report.

PMID: 30264037 [PubMed]

PMCID: PMC6155992

EC Orthopaedics
Distraction Implantation. A New Technique in Total Joint Arthroplasty and Direct Skeletal Attachment.

PMID: 30198026 [PubMed]

PMCID: PMC6124505

EC Pulmonology and Respiratory Medicine
Prevalence and factors associated with self-reported chronic obstructive pulmonary disease among adults aged 40-79: the National Health and Nutrition Examination Survey (NHANES) 2007-2012.

PMID: 30294723 [PubMed]

PMCID: PMC6169793

EC Dental Science
Important Dental Fiber-Reinforced Composite Molding Compound Breakthroughs

PMID: 29285526 [PubMed]

PMCID: PMC5743211

EC Microbiology
Prevalence of Intestinal Parasites Among HIV Infected and HIV Uninfected Patients Treated at the 1o De Maio Health Centre in Maputo, Mozambique

PMID: 29911204 [PubMed]

PMCID: PMC5999047

EC Microbiology
Macrophages and the Viral Dissemination Super Highway

PMID: 26949751 [PubMed]

PMCID: PMC4774560

EC Microbiology
The Microbiome, Antibiotics, and Health of the Pediatric Population.

PMID: 27390782 [PubMed]

PMCID: PMC4933318

EC Microbiology
Reactive Oxygen Species in HIV Infection

PMID: 28580453 [PubMed]

PMCID: PMC5450819

EC Microbiology
A Review of the CD4 T Cell Contribution to Lung Infection, Inflammation and Repair with a Focus on Wheeze and Asthma in the Pediatric Population

PMID: 26280024 [PubMed]

PMCID: PMC4533840

EC Neurology
Identifying Key Symptoms Differentiating Myalgic Encephalomyelitis and Chronic Fatigue Syndrome from Multiple Sclerosis

PMID: 28066845 [PubMed]

PMCID: PMC5214344

EC Pharmacology and Toxicology
Paradigm Shift is the Normal State of Pharmacology

PMID: 28936490 [PubMed]

PMCID: PMC5604476

EC Neurology
Examining those Meeting IOM Criteria Versus IOM Plus Fibromyalgia

PMID: 28713879 [PubMed]

PMCID: PMC5510658

EC Neurology
Unilateral Frontosphenoid Craniosynostosis: Case Report and a Review of the Literature

PMID: 28133641 [PubMed]

PMCID: PMC5267489

EC Ophthalmology
OCT-Angiography for Non-Invasive Monitoring of Neuronal and Vascular Structure in Mouse Retina: Implication for Characterization of Retinal Neurovascular Coupling

PMID: 29333536 [PubMed]

PMCID: PMC5766278

EC Neurology
Longer Duration of Downslope Treadmill Walking Induces Depression of H-Reflexes Measured during Standing and Walking.

PMID: 31032493 [PubMed]

PMCID: PMC6483108

EC Microbiology
Onchocerciasis in Mozambique: An Unknown Condition for Health Professionals.

PMID: 30957099 [PubMed]

PMCID: PMC6448571

EC Nutrition
Food Insecurity among Households with and without Podoconiosis in East and West Gojjam, Ethiopia.

PMID: 30101228 [PubMed]

PMCID: PMC6086333

EC Ophthalmology
REVIEW. +2 to +3 D. Reading Glasses to Prevent Myopia.

PMID: 31080964 [PubMed]

PMCID: PMC6508883

EC Gynaecology
Biomechanical Mapping of the Female Pelvic Floor: Uterine Prolapse Versus Normal Conditions.

PMID: 31093608 [PubMed]

PMCID: PMC6513001

EC Dental Science
Fiber-Reinforced Composites: A Breakthrough in Practical Clinical Applications with Advanced Wear Resistance for Dental Materials.

PMID: 31552397 [PubMed]

PMCID: PMC6758937

EC Microbiology
Neurocysticercosis in Child Bearing Women: An Overlooked Condition in Mozambique and a Potentially Missed Diagnosis in Women Presenting with Eclampsia.

PMID: 31681909 [PubMed]

PMCID: PMC6824723

EC Microbiology
Molecular Detection of Leptospira spp. in Rodents Trapped in the Mozambique Island City, Nampula Province, Mozambique.

PMID: 31681910 [PubMed]

PMCID: PMC6824726

EC Neurology
Endoplasmic Reticulum-Mitochondrial Cross-Talk in Neurodegenerative and Eye Diseases.

PMID: 31528859 [PubMed]

PMCID: PMC6746603

EC Psychology and Psychiatry
Can Chronic Consumption of Caffeine by Increasing D2/D3 Receptors Offer Benefit to Carriers of the DRD2 A1 Allele in Cocaine Abuse?

PMID: 31276119 [PubMed]

PMCID: PMC6604646

EC Anaesthesia
Real Time Locating Systems and sustainability of Perioperative Efficiency of Anesthesiologists.

PMID: 31406965 [PubMed]

PMCID: PMC6690616

EC Pharmacology and Toxicology
A Pilot STEM Curriculum Designed to Teach High School Students Concepts in Biochemical Engineering and Pharmacology.

PMID: 31517314 [PubMed]

PMCID: PMC6741290

EC Pharmacology and Toxicology
Toxic Mechanisms Underlying Motor Activity Changes Induced by a Mixture of Lead, Arsenic and Manganese.

PMID: 31633124 [PubMed]

PMCID: PMC6800226

EC Neurology
Research Volunteers' Attitudes Toward Chronic Fatigue Syndrome and Myalgic Encephalomyelitis.

PMID: 29662969 [PubMed]

PMCID: PMC5898812

EC Pharmacology and Toxicology
Hyperbaric Oxygen Therapy for Alzheimer's Disease.

PMID: 30215058 [PubMed]

PMCID: PMC6133268

News and Events

November Issue Release

We always feel pleasure to share our updates with you all. Here, notifying you that we have successfully released the November issue of respective journals and the latest articles can be viewed on the current issue pages.

Submission Deadline for Upcoming Issue

ECronicon delightfully welcomes all the authors around the globe for effective collaboration with an article submission for the upcoming issue of respective journals. Submissions are accepted on/before December 13, 2022.

Certificate of Publication

ECronicon honors with a "Publication Certificate" to the corresponding author by including the names of co-authors as a token of appreciation for publishing the work with our respective journals.

Best Article of the Issue

Editors of respective journals will always be very much interested in electing one Best Article after each issue release. The authors of the selected article will be honored with a "Best Article of the Issue" certificate.

Certifying for Review

ECronicon certifies the Editors for their first review done towards the assigned article of the respective journals.

Latest Articles

The latest articles will be updated immediately on the articles in press page of the respective journals.