Diabetic patients who present with ST-elevation myocardial infarction

Michael Megaly, Christian W. Schmidt, Marshall W. Dworak, Ross Garberich, Larissa Stanberry, Scott Sharkey, Emmanouil S. Brilakis, Frank V. Aguirre, Roberto Pacheco, Mark Tannenbaum, Teresa Coulson, Timothy D. Smith, Timothy D. Henry, Santiago Garcia

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
JournalCardiovascular Revascularization Medicine
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • Diabetes mellitus
  • DM
  • STEMI

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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