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Impact of diabetes mellitus on outcomes in patients with myocardial infarction according to varying degree of left ventricular systolic dysfunction

Anna A Fojt1, Robert R Kowalik1, Marek M Gierlotka2, Mariusz M Gąsior3, Cynthia C Smeding4, Grzegorz G Opolski1
DOI: 10.33963/KP.a2022.0004
·
Pubmed: 34982833
Affiliations
  1. 1st Chair and Department of Cardiology, Medical University of Warsaw, Warszawa, Poland
  2. Department of Cardiology, University Hospital, Institute of Medical Sciences, University of Opole, Opole, Poland
  3. 3rd Department of Cardiology, School of Medicine with the Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Silesian Center for Heart Diseases, Zabrze, Poland
  4. 1st Department of Obstetrics and Gynecology, Medical University of Warsaw, Warszawa, Poland

open access

Online first
Original article
Published online: 2022-01-04

Abstract

Background: Diabetes mellitus (DM) is known to contribute to unfavorable short- and long-term outcomes in patients with myocardial infarction (MI). Particularly poor outcomes are associated with left ventricular systolic dysfunction after an MI. The aim of our study was to compare the short- and long-term outcomes of MI in patients with DM and varied degrees of left ventricular systolic dysfunction with the corresponding outcomes in a non-diabetic control group.

Methods: This analysis focused on patients with MI registered in the Polish National Registry of Acute Coronary Syndrome between 2009 and 2011. For the purposes of this analysis, diabetic patients were additionally stratified into three subgroups depending on the degree of left ventricular systolic dysfunction, as assessed during their hospitalization for MI. Subsequently, the 30-day, 12-month, and 36-month outcomes in the diabetic study subgroups were compared with those in the corresponding non-diabetic subgroups.

Results: This analysis encompassed a nationwide cohort of 58,123 patients. 12- and 36- months mortality was greater in diabetic patients than in non-diabetic patients. The highest 36-month mortality (46.64%) was in the group of patients with DM and reduced EF < 40%. Multivariate analysis showed diabetes and low EF to be independent risk factors for 36-month mortality, increasing the risk of death by 35% for diabetes and by 30% for each 5-percentage point EF decrease. Higher mortality was observed in older patients, smokers, and patients with ischemic heart disease prior to the index hospitalization.

Conclusions: Both diabetes and reduced EF proved to be independent risk factors for increased mortality over long-term follow-up after MI.

Abstract

Background: Diabetes mellitus (DM) is known to contribute to unfavorable short- and long-term outcomes in patients with myocardial infarction (MI). Particularly poor outcomes are associated with left ventricular systolic dysfunction after an MI. The aim of our study was to compare the short- and long-term outcomes of MI in patients with DM and varied degrees of left ventricular systolic dysfunction with the corresponding outcomes in a non-diabetic control group.

Methods: This analysis focused on patients with MI registered in the Polish National Registry of Acute Coronary Syndrome between 2009 and 2011. For the purposes of this analysis, diabetic patients were additionally stratified into three subgroups depending on the degree of left ventricular systolic dysfunction, as assessed during their hospitalization for MI. Subsequently, the 30-day, 12-month, and 36-month outcomes in the diabetic study subgroups were compared with those in the corresponding non-diabetic subgroups.

Results: This analysis encompassed a nationwide cohort of 58,123 patients. 12- and 36- months mortality was greater in diabetic patients than in non-diabetic patients. The highest 36-month mortality (46.64%) was in the group of patients with DM and reduced EF < 40%. Multivariate analysis showed diabetes and low EF to be independent risk factors for 36-month mortality, increasing the risk of death by 35% for diabetes and by 30% for each 5-percentage point EF decrease. Higher mortality was observed in older patients, smokers, and patients with ischemic heart disease prior to the index hospitalization.

Conclusions: Both diabetes and reduced EF proved to be independent risk factors for increased mortality over long-term follow-up after MI.

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Keywords

diabetes mellitus, ejection fraction, heart failure, myocardial infarction

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Title

Impact of diabetes mellitus on outcomes in patients with myocardial infarction according to varying degree of left ventricular systolic dysfunction

Journal

Kardiologia Polska (Polish Heart Journal)

Issue

Online first

Article type

Original article

Published online

2022-01-04

DOI

10.33963/KP.a2022.0004

Pubmed

34982833

Keywords

diabetes mellitus
ejection fraction
heart failure
myocardial infarction

Authors

Anna A Fojt
Robert R Kowalik
Marek M Gierlotka
Mariusz M Gąsior
Cynthia C Smeding
Grzegorz G Opolski

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