Abstract 17059: Closing the Gap of Increased Mortality between Diabetic and Non-diabetic Patients with STEMI. Data from the USIK 1995, USIC 2000, FAST-MI 2005 and 2010 French Nationwide Registries

Abstract

Background and aim: Early mortality in diabetic patients with STEMI is known to be worse than in non-diabetic subjects. Whether this worse outcome persists with the decline in mortality observed for STEMI patients over the past 15 years is not known.

Methods: USIK 1995, USIC 2000, FAST-MI 2005 and 2010 are 4 nationwide French registries conducted 5 years apart, using a similar methodology in consecutive pts admitted to CCUs over a one-month period. Of a total of 10,521 AMI pts presenting ≤48 hrs of symptom, 6,887 with STEMI were included. Evolution of 30-d mortality was compared in the 1281 pts with DM vs the 5606 without.

Results: From 1995 to 2010, mean age of DM pts remained constant (69 years), whereas it decreased markedly in non DM pts (from 66 to 62 years). In-hospital complications decreased for both groups (DM vs no DM): reinfarction (3.0 to 1.0%; 2.5 to 1.1%), VF (5.0 to 2.3%; 4.2% to 2.9%), AF (15.3 to 9.4%; 12.2 to 4.8%), stroke (2.0 to 0.7; 0.7 to 0.7). Mortality decreased in DM patients (21.5 to 14.4 to 10.8 to 8.0%) and in non DM pts (12.1 to 7.5 to 6.7 to 4.3%). Using multivariate analysis in the whole STEMI population, DM was associated with an independent increased risk of 30-d death (OR: 1.50; 95%CI: 1.21-1.85). When time period was added to the model, DM pts remained at increased risk of death (OR: 1.53; 95%CI: 1.24-1.88), and time period (2010 vs 1995) was also an independent predictor of mortality (adjusted OR: 0.39; 95%CI 0.30-0.53). When each survey was analysed separately, DM was associated with significantly increased mortality in 1995 and 2000 (OR: 1.60; 95%CI: 1.07-2.40; OR: 1.94; 95%CI: 1.34-2.81, respectively) whereas in 2005 and 2010 the excess mortality was no longer significant (OR: 1.29; 95%CI: 0.84-1.98 and OR: 1.27; 95%CI: 0.71-2.28).

Conclusion: In these 4 nationwide surveys of STEMI patients conducted 15 years apart, early mortality decreased by more than 60% for both diabetic and non-diabetic pts. DM was associated with increased early mortality, but the excess mortality was attenuated and no longer significant after multivariate adjustment in the 2005 and 2010 surveys.