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| |  AHA: Angioplasty More Beneficial than Fibrinolytic Treatment for Diabetics With Myocardial Infarction By Bruce Wilson Special to DG News ANAHEIM, CA -- November 14, 2001 -- Primary angioplasty is preferable to fibrinolytic therapy in diabetics with acute myocardial infarction (AMI). Speaking at this year’s American Heart Association (AHA) meeting, Dr. Koon-Hou Mak from the National Heart Centre in Singapore, reported that primary percutaneous transluminal coronary angioplasty (PTCA) is associated with lower rates of early and late adverse events compared to fibrinolytic therapy in AMI patients with diabetes, as has already been proven in AMI patients without diabetes. The study involved 202 patients with diabetes mellitus and ST-segment elevation AMI. Of that total, 99 received fibrinolytic therapy and 103 were treated with primary PTCA. Among the patients receiving fibrinolytic therapy, 79 percent received streptokinase while 20 received accelerated recombinant tissue-plasminogen activator (rt-PA), including 10 patients treated with reduced dose rt-PA and abciximab. Rt-PA-treated patients also received intravenous heparin. In the PTCA group, Dr. Mak reported, primary angioplasty was performed using standard techniques and almost all patients (94.2 percent) received adjunctive coronary stenting, while a glycoprotein IIb/IIIa inhibitor was administered in 63.1 percent. All patients received aspirin, with other medications administered at the discretion of the attending cardiologist. Primary PTCA patients were treated with a second anti-platelet agent (ticlopidine 250 mg or clopidogrel 75 mg daily after an initial loading dose) prior to the procedure and for four weeks. Results found that primary PTCA was associated with a significantly lower risk of mortality or reinfarction at one-year. Older patients (65 or older), those with a higher Killip class and insulin treatment conferred a higher risk, the researchers found. The researchers cautioned that the outcome among patients treated with fibrinolytic agents may have been better if rt-PA had been used more frequently rather than streptokinase, although the absolute difference would likely have been small. As well, they noted that a higher proportion of patients with pulmonary edema and cardiogenic shock in the PTCA group may have diminished the beneficial effect of angioplasty. Nevertheless, they concluded that PTCA is an attractive alternative to fibrinolytic therapy in diabetic patients with AMI, as long as the necessary facilities and trained personnel are available.
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