NON–ST-ELEVATION MYOCARDIAL INFARCTION (NSTEMI) OUTCOMES IN TYPE 2 DIABETIC PATIENTS WITH NON-OBSTRUCTIVE CORONARY ARTERY STENOSIS: DIABETIC MYOCARDIAL INFARCTION CORONARY NON-OBSTRUCTIVE STENOSIS: DIA-MYCONOS STUDY.

Raffaele Marfella, MD, Phd, Celestino Sardu, MD, Msc, PhD*, Maria Luisa Balestrieri, PhD, Mario Siniscalchi, MD, PhD, Antonino Coppola, MD, Fabio Minicucci, MD, Pasquale Paolisso, MD, Davide D’Andrea, MD, Giuseppe Signoriello, MD, Paolo Calabrò, MD, PhD, Pier Francesco Rambaldi, MD, Ciro Mauro, MD, Maria Rosaria Rizzo, MD, PhD and Michelangela Barbieri, MD, PhD

ABSTRACT

Objective: Management of type 2 diabetic patients (DMT2) with non-obstructive coronary stenosis (NOCS) Non–ST-Elevation Myocardial Infarction (NSTEMI) is unclear. We evaluate the 12-month prognosis of DMT2 with NOCS-NSTEMI and compared them with a cohort of DMT2 with NSTEMI and obstructive coronary stenosis (OCS) treated with percutaneous coronary intervention (PCI). Methods: DIAbetic MYocardial COronary Non-Obstructive Stenosis (DIA-MYCONOS) was an observational study prospective study of NSTEMI DMT2 patients undergoing angiographic study. 1098 DMT2 patients with first NSTEMI undergoing coronary angiography were studied. Patients were categorized in two groups, either with or without OCS (stenosis >50%). OCS patients were treated with PCI and optimal medical therapy (n=922, 84%). NOCS patients were treated with optimal medical therapy alone (n=176, 16%). Endpoints included cardiac mortality, all-cause mortality and re-hospitalization for coronary disease and heart failure. Results: OCS-NSTEMI patients were undergoing to PCI plus medical therapy, whereas NOCS-NSTEMI patients were treated with medical therapy. Groups received similar secondary prevention therapies. 1098 patients were followed-up for 1 year. In-hospital mortality was similar (1.11 vs. 1.14%), and 1-year total mortality was 6.72% in NSTEMI patients with OCS treated with PCI and 11.93% in NSTEMI patients with NOCS treated with medical therapy (P<0.09). 18.3% of NSTEMI patients with OCS and 36.9% of NSTEMI patients with NOCS were re-hospitalized for cardiovascular diseases (P <0.05). Conclusions: NOCS-NSTEMI-DMT2 patients treated with medical therapy have poor prognoses as compared with OCS-NSTEMI patients treated with PCI, despite a less aggressive initial atherosclerosis. These findings evidence a possible gap in the NOCS-NSTEMI management.

Keywords: diabetes, myocardial infarction, coronary stenosis.