1. The EMERALD Trial Diabetic Substudy

2. 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;100:206-210

3. 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;100:206-210

4. EMERALD Diabetic Analysis Baseline Characteristics Marso et al. Am J Cardiol 2007;100:206-210DM (N = 62) No DM (N = 439) P-Value Age (years) 59590.79 Men (%) 77790.87 Body Mass Index (kg/m 2 ) 28270.065 Hypertension (%) 6134<0.001 Dyslipidemia (%) 44220.0004 Symptom onset to first balloon inflation (min) 2172180.57 Prior myocardial infarction (%) 11111.0 Prior coronary bypass (%) 331.0 Prior percutaneous intervention (%) 10101.0

5. EMERALD Diabetic Analysis Angiographic & Procedural Characteristics Marso et al. Am J Cardiol 2007;100:206-210 DM (N = 62) No DM (N = 439) P-Value Diseased arteries (%) 142510.22 234 1.0 342150.095 Infarct related coronary artery (%) Left anterior descending46390.33 Right39510.10 Left circumflex15100.27 Initial TIMI flow (%) 060560.58 12110.03 212140.69 327190.17

6. EMERALD Diabetic Analysis Angiographic & Procedural Characteristics DM (n=62) No DM (n=439) P- Value Initial myocardial blush grade (%) 064700.36 19130.52 217110.19 31060.25 Ejection fraction (%) 50470.87 Marso et al. Am J Cardiol 2007;100:206-210

7. EMERALD Diabetic Analysis Primary Outcomes Marso et al. Am J Cardiol 2007;100:206-210 P=1.0 P=0.002 P=0.005 P<0.0001

8. EMERALD Diabetic Analysis Primary Outcomes Marso et al. Am J Cardiol 2007;100:206-210 P=0.005

9. EMERALD Diabetic Analysis Secondary Outcomes Marso et al. Am J Cardiol 2007;100:206-210 P=0.04P=0.002 P<0.001 P=0.02

10. EMERALD Diabetic Analysis Multivariable Predictors of Complete ST-Resolution Marso et al. Am J Cardiol 2007;100:206-210OR 95% CI Chi-SquareP-Value Current smoker 1.821.09-3.045.260.02 Diabetes0.390.19-0.816.440.01 Prior myocardial infarction 0.370.17-0.796.580.01 Left anterior descending ST-elevation myocardial infarction 0.120.07-0.1965.91<0.0001

11. EMERALD Diabetic Analysis Multivariable Predictors of 6-Month Mortality Marso et al. Am J Cardiol 2007;100:206-210 HR95% CIChi-SquareP-Value Diabetes8.802.49-31.0211.440.0007 Age1.121.06-1.1915.210.0001 Baseline platelets1.011.00-1.015.360.0206 ST-segment resolution >70%0.060.01-0.486.960.0083

12. 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;100:206-210 In diabetic patients undergoing percutaneous coronary intervention: