October 30, 2024Cardiovascular Diabetology9 citationsOpen Access

Short- and long-term mortality in patients with type 2 diabetes after myocardial infarction– a nationwide registry study

AKAnne M Kerola MJMarkus Juonala VKVille Kytö

Structured PICO

Does type 2 diabetes increase short- and long-term mortality in patients after myocardial infarction?

Population

90,821 consecutive patients with an incident myocardial infarction treated in all 20 Finnish hospitals from 2004 to 2018, including 13,152 patients with type 2 diabetes (mean age 73.6 years, 40% female) and 77,669 patients without diabetes.

Intervention

Type 2 diabetes (defined by entitlement for special reimbursement for antidiabetic medications, ICD-10 code E11, and use of an oral antidiabetic medication within six months prior to index MI).

Comparator

Patients without diabetes (no entitlement to special reimbursement for antidiabetic medications, no diabetes diagnosis, and no purchases of antidiabetic medications within six months to one year prior to MI), analyzed both as an unadjusted cohort and as a 1:1 propensity score-matched cohort (12,776 pairs).

Outcome

All-cause death at 30 days, 1 year, and 15 years after the index MI.hard clinical

Type 2 diabetes remains an independent risk factor for both short- and long-term mortality after myocardial infarction, though the effect size is relatively modest and the excess risk is attenuated by increasing age.

Abstract

BACKGROUND: Type 2 diabetes has traditionally been a risk factor for worse prognosis after myocardial infarction (MI), but major advances have been made in its treatment, and the use of secondary preventive measures has intensified. We evaluated the short- and long-term mortality rates of patients with type 2 diabetes after MI and explored the associations between the characteristics of patients with type 2 diabetes and MI mortality. METHODS: Mortality rates among consecutive MI patients with type 2 diabetes using oral antidiabetic medication (n = 13,152; 40% female; mean age 73.6 years) and MI patients without diabetes (n = 77,669) treated in Finland from 2004 to 2018 were retrospectively studied using a combination of national registries (median follow-up 5.7 years). Differences between groups were balanced with multivariable adjustments and propensity score matching. RESULTS: Mortality was higher in patients with type 2 diabetes than in the propensity score-matched controls without diabetes at 30 days (12.6% versus 12.0%: p = 0.013), at 1 year (22.4% versus 21.4%; p = 0.001), and at 15 years (83.2% vs. 73.4%; HR 1.20; 95% CI 1.17-1.24; p < 0.0001) after MI. In subgroup analyses, type 2 diabetes was associated with a poorer prognosis across the spectrum of MI patients. The excess mortality risk was attenuated by increasing age but was similar in both sexes. Male sex, age, cardiovascular and noncardiovascular co-morbidities, lack of revascularization, a longer duration of diabetes, and baseline insulin therapy were associated with increased mortality in patients with type 2 diabetes. The one-year prognosis of patients with type 2 diabetes improved during the study period, but the mortality gap compared to patients without diabetes was not altered. CONCLUSIONS: Type 2 diabetes had a negative impact on both short- and long-term outcome after MI, but effect sizes were relatively small. Patients with longer duration of diabetes or need for insulin therapy are still at particular risk.

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