Abstract 12654: Clinical Characteristics and Outcomes of Patients With Insulin Receiving and Non-Insulin Receiving Diabetes Mellitus Presenting With Myocardial Infarction: An Analysis From The NCDR

Abstract

Objective: Patients with DM presenting with MI are at a higher risk of in-hospital complications. There is conflicting evidence of the added risk of insulin receiving diabetes mellitus (IRDM) vs. non-insulin receiving diabetes mellitus (NIRDM) (on oral therapy alone) in patients presenting with STEMI and NSTEMI.

Methods: We analyzed ACTION Registry®-GWTG™ data from 457 sites between January 2007 and March 2011. We identified 62,625 patients with MI who were receiving treatment for DM. Patients were divided into those with NSTEMI (n= 45415; 73%) and STEMI (N=17210; 27%) and then further divided into IRDM and NIRDM groups. Insulin receiving status was determined at time of presentation. Adjustment for co-variates was done using the ACTION in-hospital mortality model.

Results: IRDM patients with NSTEMI (n=20,051; 44%) and STEMI (n=5,811; 34%) were slightly younger, had a higher BMI, more risk factors, and were more likely to have CHF and a lower GFR on presentation than NIRDM patients. Symptom onset to hospital arrival was longer for IRDM patients in both groups. Patients with IRDM were more likely to have 3-vessel CAD, EF < 25%, were less likely to undergo catheterization and revascularization procedures and had a higher incidence of in-hospital death and major bleeding events in both groups (table). The multivariate analysis showed that risk adjusted in-hospital mortality was higher in IRDM than NIRDM patients in the NSTEMI group (OR =1.12; 1.01-1.24, 95% CI), but not in the STEMI group (OR =1.12; 0.95-1.32, 95% CI).

Conclusions: Results from this large registry of patients with MI show that among DM patients, those with IRDM present with higher risk features, yet undergo catheterization and revascularization less often than NIRDM patients. In NSTEMI but not in STEMI patients, insulin therapy was independently associated with increased mortality than NIRDM, highlighting the need for additional studies to determine the influence of specific therapies for patients with IRDM.