European Heart Journal Advance Access published online on April 19, 2005
European Heart Journal, doi:10.1093/eurheartj/ehi269
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1 Service de Cardiologie, 1/Hôpital Cardiovasculaire et Pneumologique Louis Pradel, BP Lyon-Montchat, 69394 Lyon Cedex 03, France
* To whom correspondence should be addressed. 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.
Received May 28, 2004
Revised March 15, 2005
Accepted March 17, 2005
Clinical research
Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? Data from the CAPTIM randomized clinical trial
2 Service de Cardiologie, Hôpital Bichat, Paris, France
3 Service de Pharmacologie Clinique, Faculte RTH Laennec, Lyon, France
4 SAMU 69, Lyon, France
5 SAMU 93, Bobigny, France
6 SAMU 31, Toulouse, France
7 SAMU 38, Grenoble, France
8 SAMU 63, Clermont Ferrand, France
9 Service de Cardiologie, CHU de Grenoble, France
10 Service de Cardiologie, Hôpital Cardio-Vasculaire et Pneumologique Louis Pradel, Lyon, France
Eric Bonnefoy, E-mail: eric.bonnefoy{at}hcuge.ch
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