Diabetic Patients Who Present With ST-Elevation Myocardial Infarction
Michael Megaly1, Christian W Schmidt1, Marshall W Dworak1
1Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA.
Insights
Diabetes Mellitus (DM) significantly increases mortality and major adverse cardiovascular events (MACE) in ST-segment elevation myocardial infarction (STEMI) patients. These findings highlight the need for targeted interventions for diabetic STEMI patients despite modern treatments.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Long-term outcomes for diabetic patients with ST-segment elevation myocardial infarction (STEMI) are understudied.
- Contemporary practice involves advanced therapies and revascularization strategies for STEMI.
Purpose of the Study:
- To evaluate the clinical characteristics and outcomes of STEMI patients with and without diabetes.
- To assess the impact of diabetes on in-hospital, 1-year, and 5-year mortality and major adverse cardiovascular events (MACE).
Main Methods:
- A large regional STEMI program database was analyzed.
- Included 6292 patients, with 1158 (18.4%) diagnosed with Diabetes Mellitus (DM).
- Compared outcomes including in-hospital mortality, 1-year MACE, and 5-year mortality between diabetic and non-diabetic patients.
Main Results:
- Diabetic patients were older, had more comorbidities, and were more likely to receive medical therapy without reperfusion.
- Patients with DM exhibited significantly higher in-hospital (8% vs. 5%), 1-year (8% vs. 4%), and 5-year mortality (16% vs. 9%).
- DM was independently associated with worse mortality (HR: 1.70) and MACE (HR: 1.63) on Cox analysis.
Conclusions:
- Diabetes Mellitus is an independent predictor of adverse outcomes in STEMI patients.
- Diabetic STEMI patients face higher short- and long-term morbidity and mortality.
- Despite advancements, DM remains a critical factor influencing STEMI patient outcomes.
Background:
The long-term outcomes of diabetic patients presenting with ST-segment elevation myocardial infarction (STEMI) in contemporary practice have received limited study.
Methods:
We evaluated the clinical characteristics and outcomes of STEMI patients with and without diabetes in a large regional STEMI program designed to facilitate timely primary percutaneous coronary intervention (PCI) (Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN). The primary and secondary outcome measures were in-hospital mortality, 1-year major adverse cardiovascular events (MACE) (stroke, myocardial infarction, unplanned PCI or coronary artery bypass graft [CABG] surgery, and all-cause mortality), and 5-year mortality.
Results:
Of the 6292 patients included, 1158 (18.4%) had Diabetes Mellitus (DM) (95.3% Type II, 4.7% Type I). Patients with DM were older (mean age 66 vs. 62.8 years, p < 0.01), had more co-morbidities and were more likely to receive medical therapy without reperfusion (13% vs. 10%, p = 0.003). Patients with DM had higher in-hospital (8% vs. 5%, p = 0.001), 1-year (8% vs. 4%, p < 0.001) and 5-year mortality (16% vs. 9%, p < 0.001) compared to non-diabetics. On Cox proportional hazards analysis, DM was independently associated with worse mortality (hazard ratio: 1.70, 95% confidence interval (CI): 1.32-2.19, p < 0.001) and MACE [HR: 1.63 (95% (CI)): 1.28-2.08, p < 0.001].
Conclusions:
Despite advancements in medical therapy and revascularization strategies for STEMI, DM remains independently associated with higher short- and long-term morbidity and mortality in contemporary practice.
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