scholarly journals Clinical Significance of Newly Diagnosed Diabetes Mellitus in the Era of DES for Acute Myocardial Infarction

2018 ◽  
Vol 48 (2) ◽  
pp. 168
Author(s):  
Hun-Jun Park
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Clinical Significance ◽  
Newly Diagnosed ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes

scholarly journals 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

2019 ◽  
Vol 9 (6) ◽  
pp. 616-625 ◽  
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.

P2480Sub-optimal anti-diabetic treatment in patients with pre-existing and newly diagnosed diabetes admitted for acute myocardial infarction. A study from the FAST-MI 2015 registry

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
F Schiele ◽  
E Puymirat ◽  
J Ferrieres ◽  
T Simon ◽  
N Danchin
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Newly Diagnosed ◽  
Treatment Intensification ◽  
Adjusted Risk ◽  
Risk Of Death ◽  
Diabetic Treatment ◽  
Diagnosed Diabetes ◽  
Newly Diagnosed Diabetes ◽  
Grace Score

Abstract Background In patients (pts) with Acute Myocardial Infarction (AMI), we evaluate how diabetes is detected and treated at discharge. Methods Using the French FAST-MI 2015 registry, pts were classed as non-diabetic (NonDiab), pre-existing (PreEx) or newly diagnosed (NewDiab) diabetes. PreEx was defined by history or pretreatment; NewDiab as no history, no anti-diabetic treatment plus HbA1C>6.5% or admission glucose ≥200mg/dL. Characteristics and adjusted 1-year mortality were compared. Results In 5291 FAST MI pts, 3857 (73%) were NonDiab, 1145 (21.5%) PreEx and 289 (5.5%) NewDiab (176 had glucose ≥200mg/dL; 143 had HbA1C >6.5%). PreEx pts were older, had more comorbidities, and higher GRACE score vs NonDiab. NewDiab pts had higher HbA1C (8.9%±9.2 vs 5.65%±0.38 in NonDiab; 7.5%±2.2 in PreEx). At 1 yr, diabetic pts (PreEx and/or NewDiab) had a 2.5-times higher adjusted risk of death. At discharge, DAPT, statins, ACEi and betablockers were less often prescribed in PreEx vs NonDiab or NewDiab pts. In diabetic pts, vs admission, the number of anti-diabetic treatments decreased at discharge in 11%, no change in 69% and increased in 20%. Despite higher HbA1C in NewDiab vs PreEx pts, anti-diabetics were less often prescribed in NewDiab (23%) vs PreEx pts (75%) (table). In pts with HbA1C>8%, treatment intensification was observed in 30%. Admission treatment Discharge treatment NonDiab PreEx NewDiab NonDiab PreEx NewDiab 3759 (71%) 1283 (24%) 249 (5%) 3759 (71%) 1283 (24%) 249 (5%) Any Anti Diabetic Tx 0 975 (76%) 0 51 (1%) 931 (75%) 53 (23%) Insulin 0 339 (26%) 0 2 404 (33%) 13 (6%) Biguanide 0 456 (36%) 0 2 412 (34%) 30 (13%) Sulfonylureas 0 258 (20%) 0 2 244 (20%) 4 DPP4i 0 175 (14%) 0 2 176 (14%) 6 (3%) GLP1 RAs 0 108 (8%) 0 1 117 (10%) 10 (1%) DAPT 3212 (88%) 1009 (90%) 201 (87%) Aspirin 778 (21%) 550 (45%) 66 (27%) 3533 (96%) 1170 (95%) 218 (94%) Statins 964 (25%) 721 (56%) 69 (28%) 2394 (92%) 1109 (82%) 216 (93%) ACEi/ARB 1028 (27%) 672 (53%) 69 (28%) 2744 (74%) 925 (75%) 174 (87%) Coronary Angiography 3684 (98%) 1202 (94%) 240 (96%) PCI 3010 (80%) 907 (71%) 201 (81%) Conclusions In AMI pts, 5.5% have previously unknown diabetes and have a higher risk of death, similar to that of pts with PreEx diabetes. Treatment initiation and intensification are sub-optimal.

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