Three-year mortality after acute myocardial infarction in patients with different diabetic status

Abstract

Introduction The prevalence of diabetes mellitus (DM) in patients with myocardial infarction (MI) is estimated at about 25%. Short- and long-term prognosis is worse in patients with DM and hyperglycemia compared with nondiabetics. Objectives Our aim was to analyze the impact of DM and transient hyperglycemia on in-hospital complications and long-term outcomes in patients with MI. Patient s and methods We evaluated a prospective cohort of 58 394 patients with MI in the Polish Registry of Acute Coronary Syndromes (PL-ACS) in terms of in-hospital complications and 30-day, 12-month, and 36-month outcomes between 2009 and 2012. Result s Patients with type 1 DM (T1DM) and type 2 DM (T2DM) underwent invasive diagnostic and therapeutic procedures less frequently than those without diabetes, transient hyperglycemia, and new-onset DM (P <0.001). T2DM was associated with a significantly higher risk of MI complicated by cardiogenic shock. The rates of pulmonary edema in the transient hyperglycemia group and the DM group were 2-fold higher than in the nondiabetic group (P <0.001). T1DM and T2DM were associated with a significantly higher risk of death. Unadjusted 3-year all-cause death rates in patients with T1DM, T2DM, transient hyperglycemia, new-onset diabetes and those without diabetes were 26.8%, 25.6%, 18.5%, 17.9%, and 16.2%, respectively. Hazard ratios (95% CI) adjusted for age, sex, clinical characteristics, and revascularization were 1.49 (1.12-2.00), 1.20 (1.14-1.27), 0.94 (0.67-1.31), and 0.66 (0.34-1.28), respectively. Conclusions T1DM and T2DM are associated with elevated in-hospital and long-term mortality rates after MI. Diabetics and patients with transient hyperglycemia are more likely to develop significant in-hospital complications compared with nondiabetics. No significant differences regarding acute mechanical complications were noted between populations.