Key result
Among patients presenting with acute myocardial infarction, diabetes was associated with lower rates of revascularization and higher 1-year mortality (HR 1.52; 95% CI 1.23-1.89).
Why the study?
Does the presence of diabetes affect the clinical presentation, management, and mortality of patients presenting with acute myocardial infarction?
Does the presence of diabetes affect the clinical presentation, management, and mortality of patients presenting with acute myocardial infarction?
Hazard Ratio: 1.52 (95% CI 1.23–1.89)
Patients with diabetes presenting with AMI have more atypical presentations, receive less aggressive guideline-directed management, and suffer higher mortality compared to those without diabetes.
A therosclerotic cardiovascular disease (ASCVD) remains the primary cause of morbidity and mortality globally.1 The presence of diabetes is associated with a >20% excess risk of ASCVD, 2 and ASCVD is the primary cause of morbidity and mortality in people with diabetes.3 However, despite this knowledge and improvements in approaches to preventing ASCVD, almost 50% of people with diabetes do not meet glycemic control, cholesterol, or blood pressure targets.4 Hospitalized patients with myocardial infarctions (MI) are likely to be the demographic most willing for and accepting of change in management, given that they would have just experienced a potentially lifethreatening event.In this context, in this issue of the Journal of the American Heart Association (JAHA), Jain et al 5 report on the outcomes and management of people with and without diabetes who presented with acute myocardial infarction (AMI) from the ARIC (Atherosclerosis Risk in Communities) Study's hospital surveillance in 4 US communities between 2000 and 2014.The study was well done and several salient points that emerged need to be considered: (1) The prevalence of diabetes among those presenting with AMI increased over the 15 years of surveillance with an aggregated prevalence of 40% (of note, the prevalence increased over the time period in men and stayed stable in women); (2) people with diabetes were less likely to present with an ST-elevation (9% versus 17%) or acute chest pain (72% versus 80%) and were more likely to present with acute pulmonary edema/ heart failure (40% versus 20%) and to have had prior stroke, MI, or coronary revascularization (17%, 36%, and 38% versus 7%, 27%, and 28%, respectively); (3) people with diabetes were less likely to be administered aspirin (0.95, 95% CI, 0.91-0.99)or nonaspirin antiplatelet therapy (relative risk, 0.93 [95% CI, 0.86-0.99])or to undergo invasive angiography (relative risk, 0.85 [95% CI, 0.78-0.92])or coronary revascularization (0.85 [95% CI, 0.76-0.92]);and (4) they had higher short-term, 1-year, and 2-year mortality risk (hazard ratio, 1.29 [95% CI, 0.96-1.77],1.52 [1.23-1.89],1.50 [1.17-1.77]),all when adjusting for age, race, sex, yearThe opinions expressed in this article are not necessarily those of the editors or of the American Heart Association.
No takes yet. Share an insight, caveat, or question.
Abushamat et al. (2023) conducted an editorial in Acute myocardial infarction. Diabetes vs. Without diabetes was evaluated on 1-year mortality (HR 1.52, 95% CI 1.23-1.89). Among patients presenting with acute myocardial infarction, diabetes was associated with lower rates of revascularization and higher 1-year mortality (HR 1.52; 95% CI 1.23-1.89).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: