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Cardiac mortality, diabetes mellitus, and multivessel disease in ST elevation myocardial infarction
Sonya Burgess1, Craig P Juergens2, Wesley Yang3
1Cardiology Department, Ingham Institute at Liverpool Hospital, Sydney, Australia; The University of New South Wales, Sydney, Australia; Cardiology Department, Nepean Hospital, Sydney, Australia.
Insights
Diabetic patients with ST-elevation myocardial infarction (STEMI) face higher cardiac death rates, particularly those with multivessel disease (MVD). Further trials are needed to reduce mortality in this high-risk STEMI population.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Diabetes mellitus is a known risk factor for cardiovascular disease.
- The impact of diabetes on cardiac death rates in ST-elevation myocardial infarction (STEMI) patients, especially concerning coronary artery disease burden, requires further clarification.
Purpose of the Study:
- To investigate long-term cardiac death rates in STEMI patients with and without diabetes.
- To stratify cardiac death rates based on the presence of multivessel disease (MVD) in diabetic and non-diabetic STEMI patients.
Main Methods:
- Prospective observational study of consecutive STEMI patients from 5 Australian hospitals.
- Long-term follow-up to assess cardiac death rates.
- Stratification by diabetes status and presence of multivessel disease (MVD).
Main Results:
- Diabetes was present in 18.8% of 2083 STEMI patients; 38.8% had MVD.
- Diabetic STEMI patients were more likely to have MVD (48.6% vs 36.6%).
- Diabetes was independently associated with a 67% increased risk of cardiac death (adjusted HR 1.67). MVD also increased cardiac death risk, particularly in diabetic patients (adjusted HR 1.94 in MVD subgroup).
Conclusions:
- STEMI patients with diabetes have a higher prevalence of MVD and increased rates of cardiac death.
- Both diabetes and MVD are independent risk factors for cardiac death in STEMI.
- Randomized trials are essential to develop strategies for reducing cardiac mortality in high-risk STEMI patients with diabetes and MVD.
Background:
In patients with diabetes mellitus presenting with ST elevation myocardial infarction (STEMI) the degree to which cardiac death rates may be attributed to an increased burden of coronary artery disease is not clear.
Methods:
This prospective observational study examines rates of cardiac death between those with and without diabetes at long term follow up, stratified by presence of multivessel disease (MVD), in consecutive STEMI patients from 5 Australian hospitals.
Results:
Amongst 2083 patients, 393 patients had diabetes (18.8%), and 810 (38.8%) had MVD. Patients with diabetes were more likely to have MVD 48.6% (191/393) than patients without diabetes 36.6% (619/1690; p < .001). At final follow up (median 3.6 years [IQR 2.4-5.4]) cardiac death occurred in 37/393 diabetic patients and 92/1690 nondiabetic patients (adjusted HR1.67, 95% CI 1.10-2.52). In those with MVD cardiac death occurred in 27/191 diabetic patients, and 54/619 non-diabetic patients (adjusted HR 1.94; 95% CI 1.17-3.23). In single vessel disease (SVD) cardiac death occurred in 10/202 diabetic patients, and 38/1071 non-diabetic patients (adjusted HR 1.37; 95% CI 0.65-2.89). Both diabetes and MVD were independently associated with cardiac death.
Conclusions:
STEMI patients with diabetes are more likely to have MVD, with an absolute difference in MVD rates of 12%, and higher rates of cardiac death. Randomized trials studying these high risk patients are needed to reduce cardiac mortality in patients with diabetes, MVD and STEMI.
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