Abstract 15117: Undiagnosed Diabetes at the Time of Acute Myocardial Infarction is Frequent and Associated With Poor Cardiovascular Outcomes
Introduction: Diabetes mellitus (DM) is associated with poor cardiovascular disease (CVD) outcomes, especially in the setting of acute myocardial infarction (AMI). As both a first diagnosis (dx) of DM and missed dx of incident DM also may be associated with poor outcomes; we sought to determine their frequency and related CVD impact in patients presenting with AMI.
Hypothesis: Many individuals with AMI have undiagnosed DM based on standard criteria, which leads to poor MACE outcomes.
Methods: Patients (pts) presenting with AMI between 2002 and 2013 were studied (n=5719). Criteria-defined (CD)-DM was a fasting glucose (FG) ≥126 mg/dL, a random glucose (RG) ≥200, or a hemoglobin A1c ≥6.5%. DM groups were: 1) history (hx) of DM (n=1941, 34%), 2) no hx of DM, with CD-DM undiagnosed at AMI (n=500, 9%), 3) no hx of DM, with CD-DM diagnosed (dx) at hospitalization (n=207, 4%), and 4) no hx of DM and no CD-DM (n=3071, 53%). MACE (all-cause death, MI, stroke, heart failure hospitalization) was determined at 1 year post discharge.
Results: Univariate comparisons are shown in the Table. After adjusting for covariables in a multivariate logistic regression using subjects with no hx of DM as the referent, hx of DM (OR=1.6; 95% CI: 1.3, 2.0; p<0.0001) and CD-DM without dx at AMI (OR=1.5; 95% CI: 1.3, 1.7; p<0.0001) were associated with greater risk of MACE. The difference between those with CD-DM with dx at AMI and those with no DM was not significant (OR=1.3; 95% CI: 0.9, 1.7; p=.15).
Conclusions: The prevalence of DM is high in those presenting with AMI. Recognition of undiagnosed DM in the setting of CD-DM remains poor. Furthermore, MACE outcomes are 1.5 times higher with CD-DM undiagnosed than without DM, whereas outcomes are moderated if CD-DM is recognized at the time of AMI. Protocols for more aggressive identification of incident DM should be instituted and may importantly impact clinical outcomes for pts with previously undiagnosed DM.
Author Disclosures: V.T. Le: None. S. Knight: None. J.L. Anderson: None. D.L. Lappé: None. H.T. May: None. B.D. Horne: None. J.B. Muhlestein: None.
- © 2015 by American Heart Association, Inc.