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Utilizing Percutaneous Ventricular Assist Devices in Acute Myocardial Infarction Complicated by Cardiogenic Shock
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Heart failure in patients with diabetes undergoing primary percutaneous coronary intervention

Samia Massalha1, Lior Luria1, Arthur Kerner2

  • 1Departments of Cardiology, Rambam Medical Center.

European Heart Journal. Acute Cardiovascular Care
|August 1, 2015
PubMed

Insights

Diabetes mellitus increases heart failure risk after ST-elevation myocardial infarction treated with primary percutaneous coronary intervention. Insulin-treated patients face the highest risk of heart failure readmission and mortality.

Area of Science:

  • Cardiology
  • Endocrinology
  • Public Health

Background:

  • Diabetes mellitus is a known risk factor for adverse outcomes following acute coronary syndromes.
  • Primary percutaneous coronary intervention (PCI) is a key reperfusion therapy for ST-elevation myocardial infarction (STEMI).
  • Limited data exist on diabetes' impact on heart failure risk post-primary PCI.

Purpose of the Study:

  • To investigate the impact of diabetes mellitus on heart failure risk in STEMI patients undergoing primary PCI.
  • To assess the influence of insulin treatment on these risks.
  • To evaluate long-term outcomes including mortality and recurrent infarction.

Main Methods:

  • A cohort of 958 STEMI patients treated with primary PCI was studied.
  • Patients were categorized into: no diabetes, non-insulin-treated diabetes, and insulin-treated diabetes.
  • Primary endpoint was 5-year readmission for heart failure; secondary endpoints included all-cause mortality and recurrent infarction.

Main Results:

  • Cumulative heart failure readmission rates were 8.4% (no diabetes), 15.2% (non-insulin), and 26.7% (insulin-treated).
  • Adjusted hazard ratios for heart failure were 1.95 (non-insulin) and 3.09 (insulin-treated) compared to no diabetes.
  • Higher fasting glucose levels showed a J-shaped association with mortality and direct association with heart failure.

Conclusions:

  • Diabetes mellitus independently increases heart failure readmission risk in STEMI patients post-primary PCI.
  • Insulin-treated diabetes mellitus confers a particularly high risk for heart failure and mortality.
  • Despite contemporary STEMI management, diabetes remains a significant adverse prognostic factor.
Abstract

Keywords:
Diabetesheart failuremyocardial infarctionprimary angioplastytreatment outcome

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