PURPOSE: To investigate the prognostic significance of diabetes mellitus (DM) in patients with high risk acute myocardial infarction (AMI) treated with primary percutaneous coronary intervention (pPCI) in the era of potent antithrombotics. METHODS: Data from 1230 ST-segment elevation myocardial infarction (STEMI) patients enrolled in the PRAGUE-18 (prasugrel vs. ticagrelor in pPCI) study were analyzed. Ischemic and bleeding event rates were calculated for patients with and without diabetes. The independent impact of diabetes on outcomes was evaluated after adjustment for outcome predictors. RESULTS: The prevalence of DM was 20% (N = 250). Diabetics were older and more often female. They were more likely to have hypertension, hyperlipoproteinemia, multivessel coronary disease and left main disease, and be obese. The primary net-clinical endpoint (EP) containing death, spontaneous nonfatal MI, stroke, severe bleeding, and revascularization at day 7 occurred in 6.1% of patients with, and in 3.5% of patients without DM (HR 1.8; 95% CI 0.978-3.315; P = 0.055). At one year, the key secondary endpoint defined as cardiovascular death, spontaneous MI, or stroke occurred in 8.8% with, and 5.5% without DM (HR 1.621; 95% CI 0.987-2.661; P = 0.054). In those with DM the risk of total one-year mortality (6.8% vs. 3.9% (HR 1.773; 95% CI 1.001-3.141; P = 0.047)) and the risk of nonfatal reinfarction (4.8% vs. 2.2% (HR 2.177; 95% CI 1.077-4.398; P = 0.026)) were significantly higher compared to in those without DM. There was no risk of major bleeding associated with DM (HR 0.861; 95% CI 0.554-1.339; P = 0.506). In the multivariate analysis, diabetes was independently associated with the one-year risk of reinfarction (HR 2.176; 95% Confidence Interval, 1.055-4.489; p = 0.035). CONCLUSION: Despite best practices STEMI treatment, diabetes is still associated with significantly worse prognoses, which highlights the importance of further improvements in the management of this high-risk population.

1st Department of Internal Medicine Cardioangiology ICRC Faculty of Medicine of Masaryk University and St Anne's University Hospital 65691 Brno Czech Republic

1st Department of Internal Medicine University Hospital and Faculty of Medicine Charles University 50005 Hradec Kralove Czech Republic

2nd Department of Medicine Department of Cardiovascular Medicine 1st Faculty of Medicine Charles University and General University Hospital 12808 Prague Czech Republic

AGEL Research and Training Institute Trinec Branch Cardiovascular Center Podlesi Hospital 73961 Trinec Czech Republic

Cardiocenter 3rd Faculty of Medicine Charles University and University Hospital Kralovske Vinohrady 10034 Prague Czech Republic

Cardiocenter Department of Cardiology Regional Hospital 37001 Ceske Budejovice Czech Republic

Cardiology Centre AGEL 53003 Pardubice Czech Republic

Cardiovascular Department University Hospital Ostrava 70800 Ostrava Czech Republic

Department of Cardiology University Hospital and Faculty of Medicine Charles University 30460 Plzen Czech Republic

Department of Internal Medicine and Cardiology Faculty of Medicine of Masaryk University and University Hospital 65991 Brno Czech Republic

Institute of Biostatistics and Analyses at the Faculty of Medicine and the Faculty of Science of Masaryk University 62500 Brno Czech Republic

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