Abstract 12998: Decade-Long Trends in Patient Characteristics, Management, and In-Hospital Outcomes of Diabetic Patients with Acute Myocardial Infarction
Background: Diabetic patients have historically had more complications and higher mortality rates after acute myocardial infarction (AMI) than non-diabetics. The objectives of this community-based study were to describe recent trends in patient characteristics, treatment practices, and in-hospital outcomes in diabetic compared to non-diabetic patients hospitalized with STEMI or NSTEMI.
Methods: We reviewed the medical records of 6,903 patients with a past medical history of diabetes (n =2,329) or no diabetes (n=4,574) hospitalized for STEMI (n=2,537) or NSTEMI (n=4,366) between 1997 and 2009 at 11 Massachusetts hospitals.
Results: Diabetic patients presenting with either STEMI or NSTEMI were more likely to be older, female, and to have a higher prevalence of comorbidities than non-diabetics. Compared to non-diabetics, diabetic patients were more likely to develop important in-hospital complications including heart failure (STEMI 39% vs 27%, NSTEMI 50% vs 35%) and cardiogenic shock (STEMI 10% vs 8%, NSTEMI 5.3% vs 3.2%), and to have a longer hospital stay (STEMI 6.3 vs 5.4 days, NSTEMI 6.7 vs 5.6 days). Diabetic patients were significantly more likely to be treated with angiotensin pathway inhibitors, while a similar and increasing proportion of diabetic and non-diabetic patients received aspirin, beta blockers, and statins over the study period. The proportion of diabetic and non-diabetic patients undergoing cardiac catheterization was similar, though diabetics were less likely to have been treated with PCI and more likely to have undergone CABG. The proportion of patients undergoing cardiac catheterization during hospitalization for AMI doubled during the study period, while the proportion treated with PCI increased by 3 to 4-fold. In-hospital mortality was significantly higher among diabetics compared to non-diabetics for both STEMI (13% vs 10%) and NSTEMI (11% vs 9%).
Conclusions: From 1997 to 2009, the use of interventional procedures and effective medical therapies for patients presenting with AMI increased, with a concomitant decrease in in-hospital complications and mortality. Nonetheless, diabetic patients presenting with STEMI and NSTEMI experienced more complications and higher in -hospital mortality than non-diabetics.
- © 2013 by American Heart Association, Inc.