Impact of Diabetes Mellitus on Hospital Mortality in Patients with PPCI for Left Main STEMI
DOI:
https://doi.org/10.61919/jhrr.v4i3.2054Keywords:
Diabetes Mellitus; ST-Segment Elevation Myocardial Infarction; Left Main Coronary Artery; Primary Percutaneous Coronary Intervention; In-Hospital Mortality; Cardiogenic ShockAbstract
Background: Left main ST-segment elevation myocardial infarction (STEMI) is a high-risk cardiovascular emergency associated with substantial morbidity and mortality. Diabetes mellitus may further influence clinical outcomes following primary percutaneous coronary intervention (PPCI), although its relationship with in-hospital mortality in this specific population remains insufficiently established. Objective: To compare in-hospital mortality and associated clinical and procedural characteristics between diabetic and non-diabetic patients undergoing PPCI for left main STEMI. Methods: This prospective observational comparative study was conducted at the Armed Forces Institute of Cardiology, Rawalpindi, Pakistan, from October 2023 to March 2024. A total of 100 patients undergoing PPCI for left main STEMI were included, comprising 50 diabetic and 50 non-diabetic patients. Demographic characteristics, cardiovascular risk factors, hemodynamic status, angiographic findings, procedural outcomes, and in-hospital complications were compared between groups. Results: The overall mean age was 64.2 ± 11.3 years, and 72% of patients were male. Diabetic patients were older than non-diabetic patients (66.4 ± 10.8 versus 62.0 ± 11.5 years). In-hospital mortality was 22.0% (11/50) in diabetic patients compared with 8.0% (4/50) in non-diabetic patients, representing an absolute difference of 14 percentage points. Cardiogenic shock occurred in 28.0% versus 16.0%, while mean left ventricular ejection fraction was 35.8 ± 9.6% versus 39.2 ± 10.1%, respectively. Postprocedural TIMI grade 3 flow was achieved in 76.0% of diabetic patients and 84.0% of non-diabetic patients. Differences in secondary clinical and procedural outcomes were not statistically significant. Conclusion: Diabetic patients undergoing PPCI for left main STEMI experienced higher observed in-hospital mortality than non-diabetic patients. However, the independent association between diabetes and mortality remains uncertain because of the limited sample size and absence of adjusted estimates. Larger studies are needed to clarify the contribution of diabetes and accompanying clinical risk factors to short-term outcomes. Keywords: Diabetes Mellitus; ST-Segment Elevation Myocardial Infarction; Left Main Coronary Artery; Primary Percutaneous Coronary Intervention; In-Hospital Mortality; Cardiogenic Shock.
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