Impact of Diabetes Mellitus on Myocardial Perfusion in Patients with ST-Segment Elevation Myocardial Infarction Undergoing Percutaneous Coronary Intervention Using Distal Protection Devices (Original)

Objective : The presence of diabetes mellitus (DM) is highly related to increased mortality in patients with ST-segment elevation myocardial infarction (STEMI) ; however, the mechanism(s) underlying the poor prognosis in patients with diabetes is not fully understood. In addition, although it has been reported that myocardial perfusion following primary percutaneous coronary intervention (PCI) is worse in patients with diabetes, the possible contribution of distal embolization in patients with diabetes is unclear. In the present study, we hypothesized that myocardial perfusion following primary PCI using a distal protection device would be different between patients with and without diabetes. Therefore, we evaluated the effect of DM on myocardial perfusion after primary PCI using distal protection devices, as assessed using myocardial blush grade (MBG) and ST-segment elevation resolution (STR) as clinical markers. Methods : Thirty-one patients with diabetes and 51 patients without diabetes, and having STEMI treated with primary PCI using distal protection devices within 24 hours (h) from the onset of symptoms were examined. The MBG, STR, peak creatine kinase (CK) level, and left ventricular ejection fraction (LVEF) were compared between groups with and without DM. Results : There was no significant difference in the post-procedural Thrombolysis In Myocardial Infarction (TIMI) flow grade 3 between the group with diabetes and that without (100% vs. 100%, P=1.0). However, the DM group had a significantly lower incidence of complete STR and MBG 3 than the non-DM group (complete STR : 19% vs. 56%, P<0.001 ; MBG 3 : 41% vs. 82%, P<0.001). The LVEF and peak CK levels were similar in the two groups (LVEF 62% vs. 66%, P=0.52 ; peak CK levels 3124 vs. 3229, P=0.86). Conclusions : There was no significant difference in the success rate for reperfusion, infarct size, or TIMI flow grade after primary PCI between patients with and without diabetes. However, microvascular perfusion was impaired in patients with diabetes, as estimated using STR and MBG. Compared to patients without diabetes, patients with diabetes had worse myocardial perfusion following primary PCI, even when a distal protection device combined with thrombus aspiration was used. (Jikeikai Med J 2015 ; 62 : 21-32)