Hyperglycemia, Diabetes Mellitus and the Outcomes of STEMI Patients

Cardiovascular disease is the leading cause of death worldwide. The most important cardiac emergency is ST-Segment Elevation Myocardial Infarction due to its high mortality rates, and in which early reperfusion, by Primary PCI or thrombolysis, is critical for patients outcomes. Patients with Diabetes Mellitus, one of the independent risk factors for cardiovascular disease, present specific characteristics compared to nondiabetic patients in relation to mortality and morbidity. In this trial we enrolled all patients presenting with STEMI in our Coronary Care Unit within six hours from the beginning of chest pain, dividing them into diabetic and non-diabetic patients and in subgroups depending on their admission glycemic level. We then studied their morbidity and mortality outcomes depending on the treatment strategy, i. e. conservative vs. Primary PCI vs. thrombolysis and depending on their admission glycemic level. We found that there is an important benefit from revascularization in decreasing in-hospital mortality in patients with STEMI, but such benefit is lower in diabetic patients compared to non-diabetics. At the same time, this trial showed that revascularization is associated with a lower reduction in mortality in glycemic levels greater than 180mg/dL, especially in non-diabetic patients.