Key result
The concurrent presence of diabetes mellitus and myocardial injury in emergency department patients was associated with a 52.8% 4-year mortality rate, compared to 10.9% in patients without either condition.
Why the study?
The clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department needed investigation.
Does the presence of diabetes mellitus and myocardial injury increase the risk of mortality and cardiovascular events in patients admitted to the emergency department?
Cohort (n=3,622)
No
Does the presence of diabetes mellitus and myocardial injury increase the risk of mortality and cardiovascular events in patients admitted to the emergency department?
Absolute Event Rate: 52.8% vs 10.9%
p-value: p=<0.001
The combination of diabetes mellitus and myocardial injury in emergency department patients identifies a very high-risk population for long-term mortality and cardiovascular readmissions.
BACKGROUND: This study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department. METHODS: We analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 with at least 1 cardiac Troponin I (cTnI Ultra Siemens, Advia Centaur) determination, and were classified according to the status of diabetes mellitus (DM) and myocardial injury (MI). Clinical events were evaluated in a 4-year follow-up. RESULTS: A total of 3622 patients were classified according to the presence of DM (n = 924 (25.55%)) and MI (n = 1049 (28.96%)). The proportion of MI in patients with DM was 40% and 25% in patients without DM. Mortality during follow-up was 10.9% in non-DM patients without MI, 21.3% in DM patients without MI, 40.1% in non-DM patients with MI, and 52.8% in DM patients with MI. A competitive risk model was used to obtain the Hazard Ratio (HR) for readmission for myocardial infarction or heart failure. There was a similar proportion of readmission for myocardial infarction and heart failure at a four-year follow-up in patients with DM or MI, which was much higher when DM was associated with MI, with respect to patients without DM or MI. The HR (95% Coefficient Interval) for myocardial infarction in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2511 (1592-3960), 2682 (1739-4138), and 5036 (3221-7876), respectively. The HR (95% CI) for the risk of readmission for heart failure in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2663 (1825-3886), 2562 (1753-3744) and 4292 (2936-6274), respectively. CONCLUSIONS: The association of DM and MI in patients treated in an Emergency Service identifies patients at very high risk of mortality and cardiovascular events.
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Bonet et al. (2021) conducted a cohort in Patients admitted to the emergency department requiring troponin testing (n=3,622). Diabetes mellitus and myocardial injury vs. No diabetes mellitus and no myocardial injury was evaluated on All-cause mortality at 4-year follow-up (p=<0.001). The concurrent presence of diabetes mellitus and myocardial injury in emergency department patients was associated with a 52.8% 4-year mortality rate, compared to 10.9% in patients without either condition.
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