Abstract 4089: Increment in Revascularization is Required in Patients with Diabetes in Order to Show Similar Beneficial Trends in Mortality Post-acute Myocardial Infarction: A Population-based Retrospective Cohort Study from the Province of Quebec
Objective: To compare the trends in outcomes post-acute myocardial infarction (AMI) mortality (at 30-day and 1-year) and 1-year use of cardiac procedures in patients with and without diabetes who were hospitalized for AMI in the province of Quebec (Canada) from 1996 to 2001.
Methods: AMI hospital admissions were selected using the principal diagnosis (ICD-9: 410) in the Quebec hospital discharge database. Diabetic patients were identified through the Quebec diabetes surveillance system database. Crude outcome rate were calculated by diabetes status and admission year. Poisson regression models were used to assess the temporal trend of outcomes. The models included diabetes status, age, sex, admission year and interaction terms.
Results: The study population included 17,605 diabetic and 48,195 non-diabetic patients aged ≥ 20 years. Patients with diabetes were more likely to be older and women. Length of stay, mortality rate and coronary artery by-pass graft (CABG) use were significantly higher in diabetic patients. Percutaneous coronary intervention (PCI) use was significantly higher in non-diabetic patients. Over the 6 years period, there was a significant decline respectively in 30-day and 1-year mortality rate in diabetic (−18% and −10.5%) and non-diabetic patients (−21.2% and −16.7%) (p<0.0001). This decline was similar in the two populations (p=0.631). With respect to age, the 1-year mortality decline was especially marked at younger (< 65 years) compared to older, both in diabetic (−30.2% vs. −9.3%, p=0.0004) and non-diabetic patients (−39.4% vs. −11.7%, p=0.0014). Regarding revascularization within 1-year after AMI, patients with diabetes experienced significant increase in CABG use (14.6%, p<0.0001) and PCI use (54.8%, p<0.0001). Patients without diabetes had a smaller but statistically significant increase in PCI use (43.8%, p<0.0001). The CABG use remained stable.
Conclusion: Overall, there was a similar decline in mortality rate in diabetic and non-diabetic patients, principally at younger age. However, diabetic patients had more revascularisation procedures within the year following AMI, suggesting that revascularisation therapy may be mandatory post AMI for the diabetics to benefit from a mortality viewpoint post AMI.