1. Diabetic Patients Who Present With ST-Elevation Myocardial Infarction
- Author
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Marshall W. Dworak, Scott Sharkey, Teresa Coulson, Roberto Pacheco, Larissa Stanberry, Christian W. Schmidt, Timothy D. Smith, Mark Tannenbaum, Santiago Garcia, Emmanouil S. Brilakis, Michael Megaly, Ross Garberich, Timothy D. Henry, and Frank V. Aguirre
- Subjects
medicine.medical_specialty ,medicine.medical_treatment ,Myocardial Infarction ,Revascularization ,Percutaneous Coronary Intervention ,Risk Factors ,Internal medicine ,Diabetes Mellitus ,medicine ,Humans ,cardiovascular diseases ,Myocardial infarction ,Stroke ,Aged ,Retrospective Studies ,business.industry ,Proportional hazards model ,Hazard ratio ,Percutaneous coronary intervention ,General Medicine ,medicine.disease ,Treatment Outcome ,Conventional PCI ,Cardiology ,ST Elevation Myocardial Infarction ,Cardiology and Cardiovascular Medicine ,business ,Mace - Abstract
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.
- Published
- 2022