The impact of DPP-4 inhibitors on long-term survival among diabetic patients after first acute myocardial infarction

Fig. 1. Flowchart outlining the various study cohorts. There were 186,326 patients in Taiwan between January 2000 and December 2012 with a primary diagnosis of acute myocardial infarction (AMI) (ICD codes: 410–410.92). From this group, patients were excluded who had a previous admission for AMI, who were ≤18 or ≥120 years old, and whose gender was undetermined. Among the remaining 186,112 cases with a primary diagnosis AMI, 72,924 cases had diabetes mellitus and underwent propensity score matching to controls to minimize baseline differences between the two groups. 2672 AMI patients with DPP-4i and 2672 matched controls were, therefore, included in our final analysis. AMI acute myocardial infarction, DM diabetes mellitus, DPP-4 dipeptidyl peptidase 4, PCI percutaneous coronary intervention

Fig. 2. Kaplan–Meier survival curve after first acute myocardial infarction (AMI) for gender subgroup analysis. Overall, the 3-year survival rate was higher for the DPP-4i group than for the control group (log-rank P < 0.0001, a), regardless of gender [female (b) or male subgroup (c)]

Fig. 3. Kaplan–Meier survival curve after first acute myocardial infarction (AMI) for age subgroup analysis. Patients in the DPP-4i and control groups were subdivided into three subgroups by age. Kaplan–Meier cumulative survival curves revealed better survival in all three subgroups [age <65 years (log-rank P = 0.0322, a), 65 ≤ age < 75 years (log-rank P = 0.0069, b), and age ≥75 (log-rank P = 0.0002, c)]

Fig. 4. Forest plot of hazard ratios for various patient characteristics with or without DPP-4 inhibitor (DPP-4i). DPP-4 inhibitors therapy is beneficial in both male and female patients. DPP-4i therapy is beneficial in patients who are 65 ≤ age < 75 (HR = 0.83; 95% CI 0.69–0.99; P = 0.0414). In addition, a positive effect of DPP-4i can be seen in patients without dyslipidemia (HR = 0.78; 95% CI 0.67–0.92; P = 0.0029), without peripheral vascular disease (PVD) (HR = 0.86; 95% CI 0.78–0.96; P = 0.0047), without heart failure (HF) (HR = 0.84; 95% CI 0.73–0.96; P = 0.0106), without end stage renal disease (ESRD) (HR = 0.86; 95% CI 0.77–0.95; P = 0.0035), and those without chronic obstructive pulmonary disease (COPD) (HR = 0.87; 95% CI 0.78–0.97; P = 0.0096). DPP-4i are also beneficial in patients with hypertension (HR = 0.87; 95% CI 0.78–0.97; P = 0.0103) and cerebrovascular disease (HR = 0.83; 95% CI 0.72–0.97; P = 0.018)