What does this research mean for the field?

In patients with NSTEMI, all-cause mortality was highest in heart failure with reduced ejection fraction (HFrEF) compared to mildly reduced (HFmrEF) and preserved (HFpEF) ejection fractions. Novelty: ClaimNovelty.CONFIRMATORY. Consensus alignment: ConsensusAlignment.SUPPORTS_CONSENSUS.

What question did this study set out to answer?

This study aims to investigate the 3-year outcomes of NSTEMI patients with and without diabetes based on their left ventricular ejection fraction levels.

February 6, 2026

Diabetes status and grade of left ventricular ejection fraction as predictors of outcomes in patients with Non-ST-segment elevation myocardial infarction

Key Result

In NSTEMI patients with or without diabetes, 3-year mortality was highest in HFrEF, intermediate in HFmrEF, and lowest in HFpEF subgroups.

Key Points

This study aims to investigate the 3-year outcomes of NSTEMI patients with and without diabetes based on their left ventricular ejection fraction levels.
Analyzed data from 4594 patients in the Korea acute MI registry-NIH dataset.
Classified patients into diabetes and non-diabetes groups.
Further classified patients into heart failure categories based on ejection fraction: HFrEF, HFmrEF, and HFpEF.
Primary outcome measured was all-cause mortality; secondary outcomes included cardiac death, recurrent MI, and heart failure hospitalizations.
In-hospital mortality was highest in the HFrEF subgroup for both DM and non-DM groups.
After 3 years, DM patients in the HFrEF subgroup had significantly higher all-cause mortality compared to HFmrEF and HFpEF groups.
Non-DM patients also showed higher mortality in the HFrEF group than in HFmrEF and HFpEF.
Both groups exhibited higher all-cause mortality and non-cardiac death rates in HFmrEF compared to HFpEF.

Structured PICO

Do diabetes status and left ventricular ejection fraction grade predict 3-year outcomes in patients with non-ST-segment elevation myocardial infarction?

Population

4,594 patients with non-ST-segment elevation myocardial infarction (NSTEMI) from the Korea acute MI registry-NIH dataset, classified by diabetes mellitus status (DM n=1608, non-DM n=2986) and LVEF grade (HFrEF, HFmrEF, HFpEF).

Outcome

All-cause mortalityhard clinical

In patients with NSTEMI, left ventricular ejection fraction grade strongly predicts 3-year mortality regardless of diabetes status, with the worst outcomes in HFrEF and intermediate outcomes in HFmrEF.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Abstract Background Compared to previous studies, we analyzed the 3-year outcomes in patients with and without diabetes mellitus (DM) and non-ST-segment elevation myocardial infarction (NSTEMI) according to left ventricular ejection fraction (LVEF) to provide more useful information. Methods In total, 4594 patients from the Korea acute MI registry-NIH dataset were were classified into DM (n = 1608) and non-DM (n = 2986) groups. The patients were further classified into heart failure with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) subgroups. The primary outcome measure was all-cause mortality. Secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, repeat revascularization, and hospitalization for HF (HHF). Results After adjustment, in-hospital mortality was highest in HFrEF but similar between HFmrEF and HFpEF in both DM and non-DM groups. During a 3-year follow-up period, after adjustment, in the DM group, all-cause mortality (p 0.001 for all), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, all-cause mortality (p = 0.001 and p 0.001, respectively) and CD and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both the DM and non-DM groups, all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Conclusion In this multicenter prospective registry study, patients with NSTEMI with or without DM, the 3-year outcomes were the best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.

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