Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease (Dec 2022)

Impact of Diabetes on 10‐Year Outcomes Following ST‐Segment–Elevation Myocardial Infarction: Insights From the EXAMINATION‐EXTEND Trial

  • Francesco Spione,
  • Victor Arevalos,
  • Rami Gabani,
  • Luis Ortega‐Paz,
  • Josep Gomez‐Lara,
  • Victor Jimenez‐Diaz,
  • Marcelo Jimenez,
  • Pilar Jiménez‐Quevedo,
  • Roberto Diletti,
  • Javier Pineda,
  • Gianluca Campo,
  • Antonio Silvestro,
  • Jaume Maristany,
  • Xacobe Flores,
  • Loreto Oyarzabal,
  • Guillermo Bastos‐Fernandez,
  • Andrés Iñiguez,
  • Antonio Serra,
  • Javier Escaned,
  • Alfonso Ielasi,
  • Maurizio Tespili,
  • Mattie Lenzen,
  • Nieves Gonzalo,
  • Pascual Bordes,
  • Matteo Tebaldi,
  • Simone Biscaglia,
  • Soheil Al‐Shaibani,
  • Rafael Romaguera,
  • Joan Antoni Gomez‐Hospital,
  • Josep Rodes‐Cabau,
  • Patrick W. Serruys,
  • Manel Sabaté,
  • Salvatore Brugaletta

DOI
https://doi.org/10.1161/JAHA.122.025885
Journal volume & issue
Vol. 11, no. 23

Abstract

Read online

Background Long‐term outcomes of ST‐segment–elevation myocardial infarction in patients with diabetes have been barely investigated. The objective of this analysis from the EXAMINATION‐EXTEND (10‐Years Follow‐Up of the EXAMINATION trial) trial was to compare 10‐year outcomes of patients with ST‐segment–elevation myocardial infarction with and without diabetes. Methods and Results Of the study population, 258 patients had diabetes and 1240 did not. The primary end point was patient‐oriented composite end point of all‐cause death, any myocardial infarction, or any revascularization. Secondary end points were the individual components of the primary combined end point, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. All end points were adjusted for potential confounders. At 10 years, patients with diabetes showed a higher incidence of patient‐oriented composite end point compared with those without (46.5% versus 33.0%; adjusted hazard ratio [HR], 1.31 [95% CI, 1.05–1.61]; P=0.016) mainly driven by a higher incidence of any revascularization (24.4% versus 16.6%; adjusted HR, 1.61 [95% CI, 1.19–2.17]; P=0.002). Specifically, patients with diabetes had a higher incidence of any revascularization during the first 5 years of follow‐up (20.2% versus 12.8%; adjusted HR, 1.57 [95% CI, 1.13–2.19]; P=0.007) compared with those without diabetes. No statistically significant differences were found with respect to the other end points. Conclusions Patients with ST‐segment–elevation myocardial infarction who had diabetes had worse clinical outcome at 10 years compared with those without diabetes, mainly driven by a higher incidence of any revascularizations in the first 5 years. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT04462315.

Keywords