Effect of diabetes mellitus on periprocedural myocardial infarction in patients undergoing coronary stent implantation.

BACKGROUND: Diabetic patients undergoing coronary percutaneous interventions (PCI) are still regarded as a very high risk category, due to an increased platelet reactivity and risk of complications especially in patients with inadequate glycemic control. However, while its prognostic impact on long-term outcome is well defined, still unclear is the impact of diabetes on the risk of periprocedural myocardial infarction (PMI) in patients undergoing PCI, that was therefore the aim of our study. METHODS: Myonecrosis biomarkers were dosed at intervals from 6 to 48 hours after non-emergent PCI. PMI was defined as Creatine Kinase-MB increase by 3 times the Upper Limit Normal or by 50% of an elevated baseline value, whereas periprocedural myonecrosis as Troponin I increase by 3 x ULN or 50% of baseline. RESULTS: Of 1311 patients, diabetes mellitus was found in 458 patients (34.9%) and associated with age (p = 0.03), hypertension (p < 0.001), renal failure (p = 0.01), previous MI (p = 0.03), previous coronary revascularization (p < 0.001), higher fasting glycemia and lower haemoglobin (p < 0.001), more severe coronary disease (p < 0.001), multivessel PCI (p = 0.03), coronary calcification (p = 0.003) and instent restenosis (p < 0.001), but lower presence of thrombus (p = 0.03). Diabetics were receiving significantly more frequent specific pharmacological treatment at admission. Diabetic status did not influence the risk of PMI or periprocedural myonecrosis (adjusted OR [95%CI] = 0.90[0.64-1.27], p = 0.57 and adjusted OR[95%CI] = 0.92 [0.70-1.21], p = 0.55). Among diabetic patients, we did not observe any impact of chronic glycaemic control on PMI. CONCLUSIONS: Diabetic status, independently from chronic glycaemic control, is not associated with increased risk of periprocedural MI and myonecrosis in patients undergoing PCI