Impact of diabetes on outcomes of patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease undergoing percutaneous coronary intervention

Jakob P, Varbella F, Linke A, Schwarz B, Felix SB, Seiffert M, Kesterke R, Nordbeck P, Witzenbichler B, Lang IM, Kessler M, Valina C, Dibra A, Rohla M, Moccetti M, Vercellino M, Gaede L, Bott-Flügel L, Stehli J, Candreva A, Paneni F, Templin C, Schindler M, Wischnewsky M, Zanda G, Quadri G, Mangner N, Toma A, Magnani G, Clemmensen P, Lüscher TF, Münzel T, Schulze PC, Laugwitz KL, Rottbauer W, Huber K, Neumann FJ, Schneider S, Riemer T, Weidinger F, Achenbach S, Richardt G, Kastrati A, Ford I, Ruschitzka F, Stähli BE (2025)

Publication Type: Journal article

Publication year: 2025

Journal

DOI: 10.1007/s00392-025-02745-x

Abstract

Background: Diabetic patients with ST-segment elevation myocardial infarction (STEMI) are at an increased risk of cardiovascular events as compared to non-diabetic patients. This analysis investigated outcomes of diabetic patients presenting with multivessel disease (MVD) and STEMI in a contemporary trial and the relevance of an immediate versus staged multivessel PCI strategy in this high-risk population. Methods: Patients enrolled in the MULTISTARS AMI trial were stratified according to the presence/absence of diabetes. Baseline characteristics and outcomes of diabetic and non-diabetic patients were compared. The primary end point was a composite of all-cause death, non-fatal myocardial infarction, stroke, unplanned ischemia-driven revascularization, or hospitalization for heart failure at 1 year. Results: In the MULTISTARS AMI trial, out of a total of 840 patients, 131 (15.6%) patients had diabetes. Patients with diabetes had a higher cardiovascular risk profile and worse kidney function. The occurrence of the primary end point was similar between patients with and without diabetes (HR, 1.14 (95% CI, 0.69–1.90), p-value = 0.60). Rates of non-cardiovascular death (HR, 6.53 (95% CI, 2.00–21.33)) and acute renal failure (HR, 3.23 (95% CI, 1.49–7.04)) were higher in diabetic patients as compared to non-diabetic patients. Comparing an immediate with a staged PCI strategy in diabetic patients, a numerically lower number of patients in the immediate PCI group experienced a primary end point event (10.6% vs. 16.9%, HR, 0.60 (95% CI, 0.23–1.53), p-value = 0.28). Conclusion: Among diabetic patients with STEMI and MVD, a strategy of immediate multivessel PCI may be safe and comparable to a strategy of staged multivessel PCI. Trial registration: Supported by Boston Scientific; MULTISTARS AMI ClinicalTrials.gov number, NCT03135275.

Authors with CRIS profile

Involved external institutions

Universitätsspital Zürich (USZ) Switzerland (CH) Universitätsklinikum Carl Gustav Carus Dresden Germany (DE) Universitätsklinikum Schleswig-Holstein (UKSH) Germany (DE) Universitätsmedizin Greifswald / Universitätsklinikum Greifswald Germany (DE) Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Germany (DE) Medizinische Universität Wien Austria (AT) Universitätsklinikum Freiburg Germany (DE) University of Medicine / Universiteti i Mjekësisë Albania (AL) Sigmund-Freud-Privatuniversität Wien (SFU) / Sigmund Freud University Austria (AT) Cardiocentro Ticino Switzerland (CH) Azienda Ospedaliera Nazionale SS.Antonio e Biagio e C.Arrigo Italy (IT) Klinikum Landkreis Erding Germany (DE) Universität Bremen Germany (DE) Royal Brompton Hospital United Kingdom (GB) Universitätsmedizin der Johannes Gutenberg-Universität Mainz Germany (DE) Universitätsklinikum Jena Germany (DE) Deutsches Zentrum für Herz-Kreislauf-Forschung (DZHK e.V.) Germany (DE) Universität Ulm Germany (DE) IHF GmbH Institut für Herzinfarktforschung Germany (DE) Klinik Landstraße (ehem. Krankenanstalt Rudolfstiftung) Austria (AT) University of Glasgow United Kingdom (GB) Universitätsklinikum Würzburg Germany (DE) HELIOS Kliniken Germany (DE) Azienda Ospedaliero-Universitaria di Parma / Parma University Hospital Italy (IT) Universitätsklinikum Hamburg-Eppendorf (UKE) Germany (DE)

How to cite

APA:

Jakob, P., Varbella, F., Linke, A., Schwarz, B., Felix, S.B., Seiffert, M.,... Stähli, B.E. (2025). Impact of diabetes on outcomes of patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease undergoing percutaneous coronary intervention. Clinical Research in Cardiology. https://doi.org/10.1007/s00392-025-02745-x

MLA:

Jakob, Philipp, et al. "Impact of diabetes on outcomes of patients with ST-segment elevation myocardial infarction and multivessel coronary artery disease undergoing percutaneous coronary intervention." Clinical Research in Cardiology (2025).

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