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European Heart Journal Advance Access originally published online on April 19, 2005
European Heart Journal 2005 26(17):1712-1718; doi:10.1093/eurheartj/ehi269
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© The European Society of Cardiology 2005. All rights reserved. For Permissions, please e-mail: journals.permissions@oupjournals.org

Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial

Eric Bonnefoy1,*, Philippe Gabriel Steg2, Sylvie Chabaud3, Pierre-Yves Dubien4, Frédéric Lapostolle5, Frédéric Boudet6, Jean-Michel Lacroute7, Frederic Dissait8, Gérald Vanzetto9, Alain Leizorowicz3, Paul Touboul1 for the CAPTIM investigators{dagger}

1Service de Cardiologie, Hôpital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
2Service de Cardiologie, Hôpital Bichat, Paris, France
3Service de Pharmacologie Clinique, Faculte RTH Laennec, Lyon, France
4SAMU 69, Lyon, France
5SAMU 93, Bobigny, France
6SAMU 31, Toulouse, France
7SAMU 38, Grenoble, France
8SAMU 63, Clermont Ferrand, France
9Service de Cardiologie, CHU de Grenoble, France

Received 28 May 2004; revised 15 March 2005; accepted 17 March 2005; online publish-ahead-of-print 19 April 2005.

* Corresponding author: 1/Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon-Montchat, 69394 Lyon Cedex 03, France. Tel: +33 4 72 35 75 49; fax: 33 4 72 35 73 41. E-mail address: eric.bonnefoy{at}hcuge.ch

Aims The CAPTIM study randomized patients managed within 6 h of acute ST-segment elevation myocardial infarction to primary angioplasty or prehospital fibrinolysis (rt-PA), with immediate transfer to a centre with interventional facilities. It found a similar incidence of the primary endpoint of death, recurrent MI, or stroke at 30 days with both strategies. We report here the outcome in the diabetic subgroup.

Methods and results The relationship of diabetic status (diabetics, n=103, non-diabetics, n=731) and treatment strategy with the occurrence of the primary endpoint and of death was analysed. Compared with non-diabetics, diabetics had a higher baseline risk profile, a higher rate of the primary endpoint (14.6 vs. 5.6%; P=0.002), and a high rate of mortality (8.7 vs. 3.1%; P=0.01) at 30 days. The incidence of the primary endpoint tended to be higher in diabetics randomized to prehospital fibrinolysis compared with those randomized to primary angioplasty [21.7 vs. 8.8% (10/46 vs. 5/57); RR: 2.47 (0.91–6.74); P=0.09]. This difference was driven by the higher mortality in the fibrinolysis group [13.0 vs. 5.3% (6/46 vs. 3/57); RR: 2.47 (0.7–9.4); P=0.29]. For non-diabetics, no such trend was observed. Compared with non-diabetics, diabetics had a much higher rate of rescue angioplasty (41.4 vs. 23.5%; P=0.01) and a higher mortality after rescue angioplasty [17.4 vs. 0% (4/23 vs. 0/90); P=0.001].

Conclusion These results suggest that diabetic patients presenting within 6 h of an acute myocardial infarction may derive particular benefit from a strategy of primary angioplasty. However, the small number of diabetic patients in this subgroup analysis does not allow a final conclusion and a specifically designed study is warranted.

Key Words: Diabetes • Acute myocardial infarction • Fibrinolysis • Primary angioplasty • Reperfusion


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