Abstract P229: Magnitude, Treatment, and Impact of Diabetes Mellitus in Patients Hospitalized with Non-ST Elevation Myocardial Infarction: A Community-based Study.
Background: Diabetes mellitus is a major risk factor for coronary heart disease (CHD) and CHD related mortality. Despite improvements in the medical management of patients presenting with non-ST segment elevation myocardial infarction (NSTEMI), this condition is still associated with a poor prognosis among diabetic patients. The objectives of this study in residents of a large central Massachusetts metropolitan area were to examine differences in the characteristics, treatment practices, and short-term outcomes of patients with and without a prior history of diabetes hospitalized for NSTEMI at all 11 medical centers in the Worcester, MA, metropolitan area.
Methods: Data from the Worcester Heart Attack Study were analyzed for 4,366 patients diagnosed with NSTEMI during 6 biennial years between 1997 and 2009. Of these, 1,645 (38%) had previously diagnosed diabetes based on the review of information from hospital medical records.
Results: Diabetic patients were more likely to be female, and to have a higher prevalence of several important comorbidities including hypertension (85 vs 67%), heart failure (42 vs 23%), stroke (19 vs 11%), and renal disease (32 vs 15%) compared with non-diabetics, respectively. While diabetic patients were significantly more likely to have been treated with ACE Inhibitors/ARBs (65 vs 53%), Calciumchannel blockers (33 vs 26%), diuretics (72 vs 53%), and lipid lowering medications (66 vs 60%) during their index hospitalization, a similar proportion of diabetic and non-diabetic patients received aspirin and Beta Blockers. Diabetics were significantly less likely to have been treated with PCI (24% vs 29%), but were more likely to have undergone CABG surgery (7 vs 5%) than non-diabetics. Compared with non-diabetics, diabetic patients were more likely to have developed important in-hospital clinical complications including heart failure (50 vs 36%), stroke (2.0 vs 1.6%), cardiogenic shock (5 vs. 3%), and to have a longer hospital stay (6.7 vs 5.4 days). Diabetic NSTEMI patients were at significantly higher risk for dying during hospitalization compared with non-diabetics (12 vs 9%). Multivariable adjusted models showed significant declines in hospital death rates during the years under study for both diabetic and non-diabetic patients, though diabetic patients remained at greater risk for dying during each of the years under study.
Conclusions: Our findings demonstrate that diabetic patients presenting with NSTEMI are more likely to suffer from comorbidities and remain at higher risk for developing complications or dying during hospitalization than non-diabetic patients presenting with NSTEMI at all central Massachusetts hospitals between 1997 and 2009.
Author Disclosures: H.H. Awad: None. M. Tisminetzky: None. R.J. Goldberg: None.
- © 2014 by American Heart Association, Inc.