Korean Circ J.  2024 Oct;54(10):603-615. 10.4070/kcj.2024.0017.

Impact of Complete Revascularization for Acute Myocardial Infarction In Multivessel Coronary Artery Disease Patients With Diabetes Mellitus

• Kang J
• Park S
• Han M
• Park KW
• Han JK
• Yang HM
• Kang HJ
• Koo BK
• Kim HS

• KMID: 2560643
• DOI: http://doi.org/10.4070/kcj.2024.0017

Abstract

Background and Objectives
The clinical benefits of complete revascularization (CR) in acute myocardial infarction (AMI) patients are unclear. Moreover, the benefit of CR is unknown in AMI with diabetes mellitus (DM) patients. We sought to compare the prognosis of CR and incomplete revascularization (IR) in patients with AMI and multivessel disease, according to the presence of DM.
Methods
A total of 2,150 AMI patients with multivessel coronary artery disease were analyzed. CR was defined based on the angiographic image. The primary endpoint of this study was the patient-oriented composite outcome (POCO) defined as a composite of allcause death, any myocardial infarction, and any revascularization within 3 years.
Results
Overall, 3-year POCO was significantly lower in patients receiving angiographic CR (985 patients, 45.8%) compared with IR (1,165 patients, 54.2%). When divided into subgroups according to the presence of DM, CR reduced 3-year clinical outcomes in the nonDM group but not in the DM group (POCO: 11.7% vs. 23.2%, p<0.001, any revascularization: 7.2% vs. 10.8%, p=0.024 in the non-DM group, POCO: 24.3% vs. 27.8%, p=0.295, any revascularization: 13.3% vs. 11.3%, p=0.448 in the DM group, for CR vs. IR). Multivariate analysis showed that CR significantly reduced 3-year POCO (hazard ratio, 0.52; 95% confidence interval, 0.36–0.75) only in the non-DM group.
Conclusions
In AMI patients with multivessel disease, CR may have less clinical benefit in DM patients than in non-DM patients.

Keyword

Percutaneous coronary intervention; Myocardial infarction; Coronary vessels; Myocardial revascularization; Diabetes mellitus