Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR).

Abstract

Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-requiring diabetes mellitus (NIRDM), and newly identified DM (hemoglobin A1C level >6.5%) versus patients without DM are limited. This observational study from the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (ACTION Registry-GWTG consisted of 243,861 patients with AMI from 462 US sites identified from January 2007 to March 2011 entered into the registry. Clinical characteristics, management, and in-hospital outcomes were analyzed. Patients with DM with non-ST-segment elevation myocardial infarction (NSTEMI; n = 53,094, 35%) were less likely to undergo diagnostic angiography or revascularization, whereas those with ST-segment elevation myocardial infarction (STEMI) (n = 21,507, 23%) were less likely to undergo reperfusion therapy compared with patients without DM. There was an increased adjusted risk of in-hospital mortality in the DM group in both the NSTEMI (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06 to 1.22) and STEMI (OR 1.17, 95% CI 1.07 to 1.27) population. In patients with DM, the risk-adjusted in-hospital mortality was higher in patients with IRDM than those with NIRDM in the NSTEMI group (OR 1.12, 95% CI 1.01 to 1.24) but not in the STEMI group (OR 1.12, 95% CI 0.95 to 1.32). Newly diagnosed patients with DM presenting with AMI had similar unadjusted in-hospital outcomes compared with patients without DM. In conclusion, patients with DM presenting with AMI have a higher mortality risk than patients without DM. In patients with DM, those with IRDM presenting with NSTEMI had an increased mortality than those with NIRDM.

• Authors: Talla A Rousan, Reji M Pappy, Anita Y Chen, Matthew T Roe, Jorge F Saucedo
• Journal: The American journal of cardiology (Am J Cardiol) Vol. 114 Issue 8 Pg. 1136-44 (Oct 15 2014) ISSN: 1879-1913 [Electronic] United States
• PMID: 25150136 (Publication Type: Journal Article, Multicenter Study, Observational Study, Research Support, Non-U.S. Gov't)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Glycated Hemoglobin A

Topics

• Aged
• Coronary Angiography
• Diabetes Mellitus, Type 1 (blood, complications, epidemiology)
• Diabetes Mellitus, Type 2 (blood, complications, epidemiology)
• Electrocardiography
• Female
• Follow-Up Studies
• Glycated Hemoglobin (metabolism)
• Hospital Mortality (trends)
• Humans
• Inpatients
• Male
• Middle Aged
• Morbidity (trends)
• Myocardial Infarction (complications, diagnosis, surgery)
• Myocardial Revascularization
• Retrospective Studies
• Risk Assessment
• Risk Factors
• Survival Rate (trends)
• United States (epidemiology)