People with Diabetes 60% More Likely to Require Revascularization Following STEMI

An analysis of data from the EXAMINATION-EXTEND trial indicates people with diabetes had a 31% greater risk of the trial's patient-oriented composite end point following ST-segment-elevation myocardial infarction (STEMI) than their counterparts without diabetes.

Using 10-year outcomes of data of patients with STEMI within the trial, results of the study indicate those with diabetes had a 31% greater risk of the composite end point of all‐cause death, any myocardial infarction, or any revascularization than their counterparts without diabetes, with this effect primarily driven by a 61% increase in risk of revascularization among those with diabetes.

“Patients with diabetes have a higher risk of stent‐related events and adverse cardiovascular events after percutaneous coronary intervention, especially in a thrombotic clinical situation such as ST‐segment–elevation myocardial infarction,” wrote investigators. “Future studies should be focused on either dedicated stents on population with diabetes or specific long‐term pharmacological treatments.”

Citing a lack of dedicated research into the long-term outcomes of people with diabetes with STEMI, a team of investigators sought to explore trends in this area through a potshot analysis of the EXAMINATION-EXTEND trial. Launched with the intent of comparing clinical outcomes of the everolimus-eluting stent against a bare metal stent in patients with STEMI, the randomized, multicenter, controlled, all‐comer EXAMINATION trial enrolled 1504 patients. An investigator-driven extension of this trial, the EXAMINATION-EXTEND trial was launched after the initial 5-year follow-up and examined the trial’s endpoints of interest out to 10 years.

Using data from the trial, Investigators designed a posthoc analysis to assess incidence of a patient-oriented combined end pint of all-cause death, any myocardial infarction, and any revascularization at 10 years. The analysis also included multiple secondary outcomes, including individual portions of the composite endpoint, cardiac death, target vessel myocardial infarction, target lesion revascularization, and stent thrombosis. Of the 1498 patients eligible for inclusion, 258 had diabetes and 1240 did not.

Upon analysis, results indicated those with diabetes had a higher incidence of the composite primary end point compared to their counterparts without diabetes (46.5% vs 33.0%; aHR, 1.31 [95% CI, 1.05-1.61]; P=.016). Analysis of secondary end points demonstrated this apparent increase in risk was driven primarily by an increase in the incidence of any revascularization (24.4% vs 16.6%; aHR, 1.61 [95% CI, 1.19-2.17]; P=.002). Further analysis of this trend revealed those with diabetes had an increased risk of revascularization during the first 5 years of follow-up relative to their counterparts without diabetes (20.2% vs 12.8%; aHR, 1.57 [95% CI, 1.13-2.19]; P=.007).

“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,” investigators added.

This study, "Impact of Diabetes on 10‐Year Outcomes Following ST‐Segment–Elevation Myocardial Infarction: Insights From the EXAMINATION‐EXTEND Trial,” was published in the Journal of the American Heart Association.