Diabetes Mellitus and Acute Myocardial Infarction: Impact on Short and Long-Term Mortality

BackgroundThe harmful effect of diabetes mellitus (DM) on mortality in patients with acute myocardial infarction (AMI) remains controversial. Furthermore, few studies focused on critical AMI patients. We aimed to address whether DM increases short- and long-term mortality in this specific population.MethodsWe analyzed AMI patients admitted into coronary care unit (CCU) with follow-up of ≥1 year from two cohorts (MIMIC-III, Medical Information Mart for Intensive Care III; CIN, Cardiorenal ImprovemeNt Registry) in the United States and China. Main outcome was mortality at 30-day and 1-year following hospitalization. Kaplan-Meier curves and Cox proportional hazards models were constructed to examine the impact of DM on mortality in critical AMI patients.Results1774 critical AMI patients (mean age 69.3 ± 14.3 years, 46.1% had DM) were included from MIMIC-III and 3380 from the CIN cohort (mean age 62.2 ± 12.2 years, 29.3% had DM). In both cohorts, DM group was older and more prevalent in cardio-renal dysfunction than non-DM group. Controlling for confounders, DM group has a significantly higher 30-day mortality (adjusted odds ratio (aOR) (95% CI): 2.71 (1.99-3.73) in MIMIC-III; aOR (95% CI): 9.89 (5.81-17.87) in CIN), and increased 1-year mortality (adjusted hazard ratio (aHR) (95% CI): 1.91 (1.56-2.35) in MIMIC-III; aHR (95% CI): 2.62(1.99-3.45) in CIN) than non-DM group.ConclusionsTaking into account cardio-renal function, critical AMI patients with DM have a higher 30-day mortality and 1-year mortality than non-DM group in both cohorts. Further studies on prevention and management strategies for DM are needed for this population.Clinical Trial Registrationclinicaltrials.gov, NCT04407936.

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Improved but still high short- and long-term mortality rates after myocardial infarction in patients with diabetes mellitus: a time-trend report from the Swedish Register of Information and Knowledge about Swedish Heart Intensive Care Admission

Heart ◽

10.1136/hrt.2006.097956 ◽

2006 ◽

Vol 93 (12) ◽

pp. 1577-1583 ◽

Cited By ~ 95

Author(s):

A. Norhammar ◽

J. Lindback ◽

L. Ryden ◽

L. Wallentin ◽

U. Stenestrand ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Intensive Care ◽

Time Trend ◽

Mortality Rates ◽

Intensive Care Admission ◽

Patients With Diabetes ◽

Short And Long Term ◽

Long Term Mortality

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Short- and long-term mortality for patients undergoing primary angioplasty for acute myocardial infarction

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(00)00866-4 ◽

2000 ◽

Vol 36 (4) ◽

pp. 1194-1201 ◽

Cited By ~ 52

Author(s):

Edward L Hannan ◽

Michael J Racz ◽

Djavad T Arani ◽

Thomas J Ryan ◽

Gary Walford ◽

...

Keyword(s):

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Primary Angioplasty ◽

Short And Long Term ◽

Long Term Mortality

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Long-term mortality in patients with diabetes mellitus type 2 after acute myocardial infarction

Opsta medicina ◽

10.5937/opmed1402042m ◽

2014 ◽

Vol 20 (1-2) ◽

pp. 42-51

Author(s):

Dusan Miljkovic

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Diabetes Mellitus Type 2 ◽

Diabetes Mellitus Type ◽

Patients With Diabetes ◽

Long Term Mortality

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Impact of elevated HbA1c on long-term mortality in patients presenting with acute myocardial infarction in daily clinical practice: insights from a ‘real world’ prospective registry of the Zwolle Myocardial Infarction Study Group

European Heart Journal Acute Cardiovascular Care ◽

10.1177/2048872619849921 ◽

2019 ◽

Vol 9 (6) ◽

pp. 616-625 ◽

Cited By ~ 3

Author(s):

Renicus S Hermanides ◽

Mark W Kennedy ◽

Elvin Kedhi ◽

Peter R van Dijk ◽

Jorik R Timmer ◽

...

Keyword(s):

Diabetes Mellitus ◽

Myocardial Infarction ◽

Acute Myocardial Infarction ◽

Clinical Outcome ◽

Newly Diagnosed ◽

Diagnosed Diabetes ◽

Newly Diagnosed Diabetes ◽

Long Term Mortality ◽

Diabetes Patients

Background: Long-term clinical outcome is less well known in up to presentation persons unknown with diabetes mellitus who present with acute myocardial infarction and elevated glycosylated haemoglobin (HbA1c) levels on admission. We aimed to study the prognostic impact of deranged HbA1c at presentation on long-term mortality in patients not known with diabetes, presenting with acute myocardial infarction. Methods: A single-centre, large, prospective observational study in patients with and without known diabetes admitted to our hospital for ST-segment elevation myocardial infarction (STEMI) and non-STEMI. Newly diagnosed diabetes mellitus was defined as HbA1c of 48 mmol/l or greater and pre-diabetes mellitus was defined as HbA1c between 39 and 47 mmol/l. The primary endpoint was all-cause mortality at short (30 days) and long-term (median 52 months) follow-up. Results: Out of 7900 acute myocardial infarction patients studied, 1314 patients (17%) were known diabetes patients. Of the 6586 patients without known diabetes, 3977 (60%) had no diabetes, 2259 (34%) had pre-diabetes and 350 (5%) had newly diagnosed diabetes based on HbA1c on admission. Both short-term (3.9% vs. 7.4% vs. 6.0%, p<0.001) and long-term mortality (19% vs. 26% vs. 35%, p<0.001) for both pre-diabetes patients as well as newly diagnosed diabetes patients was poor and comparable to known diabetes patients. After multivariate analysis, newly diagnosed diabetes was independently associated with long-term mortality (hazard ratio 1.72, 95% confidence interval 1.27–2.34, P=0.001). Conclusions: In the largest study to date, newly diagnosed or pre-diabetes was present in 33% of acute myocardial infarction patients and was associated with poor long-term clinical outcome. Newly diagnosed diabetes (HbA1c ⩾48 mmol/mol) is an independent predictor of long-term mortality. More attention to early detection of diabetic status and initiation of blood glucose-lowering treatment is necessary.

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