The EMERALD Trial Diabetic Substudy. EMERALD Diabetic Analysis To compare myocardial perfusion and infarct sizes in diabetic and non-diabetic patients.

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The EMERALD Trial Diabetic Substudy

EMERALD Diabetic Analysis To compare myocardial perfusion and infarct sizes in diabetic and non-diabetic patients undergoing primary percutaneous coronary intervention (PCI) in the EMERALD (Enhanced Myocardial Efficacy and Removal by Aspiration of Liberated Debris) trial for ST-segment elevation myocardial infarction Objective Marso et al. Am J Cardiol 2007;100:

EMERALD Diabetic Analysis Study Design Primary Outcome ST-resolution at 30 minutes Infarct size at days 5-14 Secondary Outcome Final TIMI flow Myocardial blush Angiographic complications Inclusion Age>18 years Acute myocardial infarction >6 hours ST-elevation ≥2mm in ≥contiguous leads, LBBB Exclusion Multivessel PCI Unprotected left main PCI Expected CABG within 30 days Marso et al. Am J Cardiol 2007;100:

EMERALD Diabetic Analysis Baseline Characteristics Marso et al. Am J Cardiol 2007;100: DM (N = 62) No DM (N = 439) P-Value Age (years) Men (%) Body Mass Index (kg/m 2 ) Hypertension (%) 6134<0.001 Dyslipidemia (%) Symptom onset to first balloon inflation (min) Prior myocardial infarction (%) Prior coronary bypass (%) Prior percutaneous intervention (%)

EMERALD Diabetic Analysis Angiographic & Procedural Characteristics Marso et al. Am J Cardiol 2007;100: DM (N = 62) No DM (N = 439) P-Value Diseased arteries (%) Infarct related coronary artery (%) Left anterior descending Right Left circumflex Initial TIMI flow (%)

EMERALD Diabetic Analysis Angiographic & Procedural Characteristics DM (n=62) No DM (n=439) P- Value Initial myocardial blush grade (%) Ejection fraction (%) Marso et al. Am J Cardiol 2007;100:

EMERALD Diabetic Analysis Primary Outcomes Marso et al. Am J Cardiol 2007;100: P=1.0 P=0.002 P=0.005 P<0.0001

EMERALD Diabetic Analysis Primary Outcomes Marso et al. Am J Cardiol 2007;100: P=0.005

EMERALD Diabetic Analysis Secondary Outcomes Marso et al. Am J Cardiol 2007;100: P=0.04P=0.002 P<0.001 P=0.02

EMERALD Diabetic Analysis Multivariable Predictors of Complete ST-Resolution Marso et al. Am J Cardiol 2007;100: OR 95% CI Chi-SquareP-Value Current smoker Diabetes Prior myocardial infarction Left anterior descending ST-elevation myocardial infarction <0.0001

EMERALD Diabetic Analysis Multivariable Predictors of 6-Month Mortality Marso et al. Am J Cardiol 2007;100: HR95% CIChi-SquareP-Value Diabetes Age Baseline platelets ST-segment resolution >70%

EMERALD Diabetic Analysis Myocardial reperfusion is decreased as measured by incomplete ST-resolution and myocardial blush gradeMyocardial reperfusion is decreased as measured by incomplete ST-resolution and myocardial blush grade Lower rates of reperfusion are associated with greater infarct sizes compared to non-diabetic patientsLower rates of reperfusion are associated with greater infarct sizes compared to non-diabetic patients There is no additional benefit of using distal embolic protection, similar to non-diabetic patientsThere is no additional benefit of using distal embolic protection, similar to non-diabetic patients Myocardial reperfusion is decreased as measured by incomplete ST-resolution and myocardial blush gradeMyocardial reperfusion is decreased as measured by incomplete ST-resolution and myocardial blush grade Lower rates of reperfusion are associated with greater infarct sizes compared to non-diabetic patientsLower rates of reperfusion are associated with greater infarct sizes compared to non-diabetic patients There is no additional benefit of using distal embolic protection, similar to non-diabetic patientsThere is no additional benefit of using distal embolic protection, similar to non-diabetic patients Conclusions Marso et al. Am J Cardiol 2007;100: In diabetic patients undergoing percutaneous coronary intervention: