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01.12.2018 | Research | Ausgabe 1/2018 Open Access

Diabetology & Metabolic Syndrome 1/2018

Effects of incretin treatment on cardiovascular outcomes in diabetic STEMI-patients with culprit obstructive and multivessel non obstructive-coronary-stenosis

Zeitschrift:
Diabetology & Metabolic Syndrome > Ausgabe 1/2018
Autoren:
Raffaele Marfella, Celestino Sardu, Maria Luisa Balestrieri, Mario Siniscalchi, Fabio Minicucci, Giuseppe Signoriello, Paolo Calabrò, Ciro Mauro, Gorizio Pieretti, Antonino Coppola, Gianfranco Nicoletti, Maria Rosaria Rizzo, Giuseppe Paolisso, Michelangela Barbieri
Wichtige Hinweise
Raffaele Marfella, Celestino Sardu, Maria Luisa Balestrieri, Mario Siniscalchi, Fabio Minicucci, Giuseppe Signoriello, Paolo Calabrò, Ciro Mauro, Gorizio Pieretti, Antonino Coppola, Gianfranco Nicoletti, Maria Rosaria Rizzo, Giuseppe Paolisso and Michelangela Barbieri contributed equally to this work
Raffaele Marfella and Celestino Sardu shares first authorship

Abstract

Background

No proper data on prognosis and management of type-2 diabetic ST elevation myocardial infarction (STEMI) patients with culprit obstructive lesion and multivessel non obstructive coronary stenosis (Mv-NOCS) exist. We evaluated the 12-months prognosis of Mv-NOCS-diabetics with first STEMI vs.to non-diabetics, and then Mv-NOCS-diabetics previously treated with incretin based therapy vs. a matched cohort of STEMI-Mv-NOCS never treated with such therapy.

Methods

1088 Patients with first STEMI and Mv-NOCS were scheduled for the study. Patients included in the study were categorized in type 2 diabetics (n 292) and non-diabetics (n 796). Finally, we categorized diabetics in current-incretin-users (n 76), and never-incretin-users (n 180). The primary end point was all cause deaths, cardiac deaths, and major adverse cardiac events (MACE) at 12 months of follow up.

Results

The study results evidenced higher percentage of all cause deaths (2.2% vs. 1.1%, p value 0.05), cardiac deaths (1.6% vs. 0.5%, p value 0.045), and MACE (12.9% vs. n 5.9%), p value 0.001) in diabetic vs. no diabetic patients at 12 months follow up. Among diabetic patients, the current vs never-incretin-users, did not present a significant difference about all cause of deaths, and cardiac deaths through 12-months. The MACE rate at 1 year was 7.4% in diabetic incretin-users STEMI Mv-NOCS patients vs. 12.9% in diabetic never-incretin-users STEMI-Mv-NOCS patients (p value 0.04). In a risk-adjusted hazard analysis, MACE through 12 months were lower in diabetic STEMI-Mv NOCS incretin-users vs never-incretin-users patients (HR 0.513, CI [0.292–0.899], p 0.021). Consequently, lower levels of glucagon-like peptide 1(GLP-1) were predictive of MACE at follow up (HR 1.528, CI [1.059–2.204], p 0.024).

Conclusion

In type 2 diabetic patients with STEMI-Mv-NOCS, we observed higher incidence of 1-year mortality and adverse cardiovascular outcomes, as compared to non-diabetic STEMI-Mv-NOCS patients. In diabetic patients, never-incretin-users have worse prognosis as compared to current-incretin-users.
Trail registration Clinical trial number: NCT03312179, name of registry: clinicaltrialgov, URL: clinicalltrialgov.com, date of registration: September 2017, date of enrollment first participant: September 2009
Literatur
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