BACKGROUND Recently, several randomized trials have noted improved outcomes with staged percutaneous coronary intervention (PCI) of nonculprit vessels in patients with ST-segment elevation myocardial infarction (STEMI) and multivessel disease. However, it remains unclear whether diabetes status affects the outcomes after different revascularization strategies. This study thus compared the impact of diabetes status on long-term outcomes after staged complete revascularization with that after culprit-only PCI. METHODS From January 2006 to December 2015, 371 diabetic patients (staged PCI: 164, culprit-only PCI: 207) and 834 nondiabetic patients (staged PCI: 412, culprit-only PCI: 422) with STEMI and multivessel disease were enrolled. The primary endpoint was 5-year major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of all-cause death, myocardial infarction (MI), stroke or unplanned revascularization. RESULTS The rate of the 5-year composite primary endpoint for diabetic patients was close to that for nondiabetic patients (34.5% vs. 33.7%; adjusted hazard ratio [HR] 1.012, 95% confidence interval [CI] 0.815-1.255). In nondiabetic patients, the 5-year risks of MACCE (31.8% vs. 35.5%; adjusted HR 0.638, 95% CI 0.500-0.816), MI (4.6% vs. 9.2%; adjusted HR 0.358, 95% CI 0.200-0.641), unplanned revascularization (19.9% vs. 24.9%; adjusted HR 0.532, 95% CI 0.393-0.720), and the composite of cardiac death, MI or stroke (11.4% vs. 15.2%; adjusted HR 0.621, 95% CI 0.419-0.921) were significantly lower after staged PCI than after culprit-only PCI. In contrast, no significant difference was found between the two groups with respect to MACCE, MI, unplanned revascularization, and the composite of cardiac death, MI or stroke in diabetic patients. Significant interactions were found between diabetes status and revascularization assignment for the composite of cardiac death, MI or stroke (Pinteraction = 0.013), MI (Pinteraction = 0.005), and unplanned revascularization (Pinteraction = 0.013) at 5 years. In addition, the interaction tended to be significant for the primary endpoint of MACCE (Pinteraction = 0.053). Moreover, the results of propensity score-matching analysis were concordant with the overall analysis in both diabetic and nondiabetic population. CONCLUSIONS In patients with STEMI and multivessel disease, diabetes is not an independent predictor of adverse cardiovascular events at 5 years. In nondiabetic patients, an approach of staged complete revascularization is superior to culprit-only PCI, whereas the advantage of staged PCI is attenuated in diabetic patients. Trial registration This study was not registered in an open access database.

中文翻译：

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ST段抬高型心肌梗塞和糖尿病患者的分期完全血运重建或仅采用罪犯经皮冠状动脉介入治疗多支冠状动脉疾病。

背景技术近来，一些随机试验已经注意到，对于患有ST段抬高型心肌梗塞（STEMI）和多支血管疾病的患者，使用非罪犯血管的分期经皮冠状动脉介入治疗（PCI）可以改善预后。但是，尚不清楚在不同的血运重建策略后，糖尿病状态是否会影响预后。因此，本研究比较了分阶段完全血运重建后的糖尿病状态对长期结局的影响与仅行PCI的情况。方法自2006年1月至2015年12月，纳入371例患有STEMI和多支血管疾病的糖尿病患者（分期PCI：164，仅罪犯PCI：207）和834例非糖尿病患者（分期PCI：412，仅罪犯PCI：422）。主要终点为5年严重心脏和脑血管不良事件（MACCE），定义为全因死亡，心肌梗塞（MI），中风或计划外血运重建的复合物。结果糖尿病患者5年综合主要终点指标的比率接近非糖尿病患者（34.5％vs. 33.7％；危险比[HR] 1.012，95％置信区间[CI] 0.815-1.255）。在非糖尿病患者中，MACCE的5年风险（31.8％vs.35.5％; HR调整后的0.638，95％CI 0.500-0.816），MI（4.6％vs. 9.2％;调整后的HR 0.358，95％CI 0.200-0.641 ），计划外血运重建（19.9％vs. 24.9％;调整后HR 0.532，95％CI 0.393-0.720），以及心脏死亡，心梗或中风的综合因素（11.4％vs. 15.2％;调整后HR 0.621，95％CI 0.419 -0.921）显着低于分期PCI后的分期PCI。相比之下，两组在MACCE，MI，糖尿病患者的计划外血运重建以及心源性死亡，心梗或中风的综合症。在5年时，由于心脏死亡，心梗或中风（交互作用= 0.013），心梗（交互作用= 0.005）和计划外血运重建（交互作用= 0.013）的复合体，在糖尿病状态和血运重建分配之间发现了显着的相互作用。此外，对于MACCE的主要终点，这种相互作用趋于显着（相互作用= 0.053）。此外，在糖尿病人群和非糖尿病人群中，倾向得分匹配分析的结果与总体分析一致。结论在患有STEMI和多支血管疾病的患者中，糖尿病并不是5年后不良心血管事件的独立预测因子。在非糖尿病患者中，分期完全血运重建的方法优于仅罪魁祸首的PCI，而分期PCI的优势在糖尿病患者中减弱了。试用注册该研究未在开放访问数据库中注册。