Abstract 13755: Impact of Diabetes on Clinical Findings, Management, and In-Hospital Outcomes in Non ST Elevation and ST Elevation Myocardial Infarction: An Analysis from the NCDR ®
Objective and Background: Several studies have shown that patients with diabetes mellitus (DM) presenting with myocardial infarction (MI) have higher mortality compared to those without DM. There is a lack of contemporary data on the clinical relevance of DM in patients presenting with NSTEMI and STEMI.
Methods: We analyzed ACTION Registry®-GWTG™ data from over 462 sites between January 2007 and March 2011. We identified 150,292 NSTEMI and 93,569 STEMI patients and further divided each group into those with and without DM. Adjustment for co-variates was done using the ACTION in-hospital mortality model.
Results: DM patients with NSTEMI (n=53,094; 35%) and STEMI (n=21,507; 23%) had more risk factors and were more likely to have CHF and lower GFR on presentation. While, DM patients in both groups were more likely to have 3-vessel CAD, those with NSTEMI were less likely to have catheterization or revascularization and those with STEMI were less likely to undergo coronary reperfusion. DM patients with NSTEMI and STEMI had a significantly higher incidence of in-hospital mortality, and major bleeding (Table) as compared to no DM. The multivariate analysis demonstrated an increased adjusted risk of in-hospital mortality in the DM group than in the no DM group in both the NSTEMI (OR=1.14, 1.06-1.22, 95% CI) and STEMI (OR=1.17, 1.07-1.27, 95% CI) population.
Conclusion: There is a high prevalence of DM in MI patients, and DM is more common in the NSTEMI than in the STEMI population. Despite higher risk status, diabetics with NSTEMI and STEMI have a lower likelihood of invasive management. DM patients with NSTEMI and STEMI have a higher risk of mortality and bleeding complications. Therefore, novel treatment strategies that target diabetic patients with MI are warranted.
- © 2012 by American Heart Association, Inc.