924-119 Angiographic Findings in Diabetics Treated with Thrombolytic Therapy After Acute Myocardial Infarction

The GUSTO Angiographic Study has shown that some Subgroups with particularly high mortality rates (such as elderly patients) have less recovery of left ventricular (LV) function despite documented infarct related artery (IRA) patency. In order to investigate the correlates of a known higher mortality associated with diabetes mellitus (DM) in the setting of acute myocardial infarction (AMI), we examined IRA patency and LV function in the GUSTO Angiographic Study cohort of 160 patients with DM and 1019 non-diabetics (NDM) randomized to 90 minute and 5–7 day follow-up catheterization after initiation of thrombolytic therapy. The thirty day mortality for DM was 11.9% and 5.8% for NDM (p=0.004). At 90min angiography, 65 (40.6%) of DM had normal (TIMI3) IRA flow compared with 385 (37.8%) of NDM (p=NS). Total patency rates at 90min (TIMI 2 and 3 combined) were 70.1% for DM and 66.6% for NDM (p=NS). Left ventricular (LV) function indices expressed by ejection fraction (EF), extent of infarct (# of abnormal chords) and regional wall motion (SD/Chord) at 90min and 5–7 day follow-up ventriculography are shown below (all p=NS).90 Min Ventriculography5–7 Day VentriculographyDMNDMDMNDMEF(%)60 ± 4560±0.759±1.760±0.7# Chords20±1.922±0.915±1917±0.9SD/Chords-2.4±0.1-2.4±0.1-2.0±0.2-19±0.1ConclusionThe excess mortality in AMI in diabetic patients cannot be explained by patency rates (equivalent to non-diabetics) nor by initial or followup regional or global left ventricular function