Diabetes Associated with Higher Risk of Death in Persons Hospitalized with Acute Myocardial Infarction

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Diabetes is associated with a higher risk of mortality in patients hospitalized with acute myocardial infarction (AMI), according to newly published data from the Atherosclerosis Risk in Communities (ARIC) study.

Among participants hospitalized with AMI, those with diabetes experienced a 52% higher 1-year mortality risk compared to those without diabetes, according to findings published in the Journal of the American Heart Association.

AMI is the leading cause of morbidity and mortality in patients with diabetes, however, “the demographic trends, clinical presentation, management, and outcomes of patients with diabetes who are hospitalized with AMI have not been recently reported,” wrote researchers.

To look deeper on the impact of diabetes in this population, investigators analyzed data from the ARIC study surveillance population, “a unique population limited to hospitalized AMI,” stated first author Vardhmaan Jain, a cardiology fellow at Emory University School of Medicine, and colleagues.

The ARIC study conducted hospital surveillance of AMI in 4 US communities between 1987 and 2014, but researchers limited the current analysis to hospitalizations from 2000 to 2014. AMI was classified by physician review using a validated algorithm and medications and procedures were abstracted from the medical record, according to the study.

Researchers enrolled 9982 eligible patients who had been hospitalized for AMI between 2000 and 2014, “which corresponded to 21 094 weighted hospitalizations.” The study cohort was predominantly White (63%), male (63%), and had a mean age of 60 years.

Findings

Among the cohort, the prevalence of diabetes increased from 35% in 2000-2004 to 41% in 2005-2009 and 43% in 2010-2014 (P-trend <.001), according to the results.

Compared to participants without diabetes, those with diabetes were slightly older (61 years vs 59 years), more often Black (44% vs 31%), and more commonly women (42% vs 34%).

The burden of cardiometabolic comorbidities, such as chronic kidney disease, hypertension, and smoking, was higher among participants with diabetes and increased temporally.

Patients with diabetes presented less often with ST‐segment elevation (9% vs 17%) or acute chest pain (72% vs 80%) compared to those without diabetes. Also, participants with diabetes had higher scores than those without diabetes on the following scales: GRACE (Global Registry of Acute Coronary Syndrome; 123 vs 109), TIMI (Thrombolysis in Myocardial Ischemia; 4.3 vs 4), and Killip class (1.9 vs 1.5).

Adults with diabetes had a lower adjusted probability of receiving aspirin (relative probability, 0.95, 95% CI 0.91–0.99), nonaspirin antiplatelet agents (0.93, 95% CI 0.86–0.99), coronary angiography (0.85, 95% CI 0.78–0.92), and coronary revascularization (0.85, 95% CI 0.76–0.92), noted investigators.

After study authors adjusted for age, race, sex, year of admission, hospital, smoking, hypertension, prior MI, and history of stroke, they found that patients with diabetes had a 29% higher short-term mortality risk compared to those without diabetes (hazard ratio [HR] 1.29, 95% CI 0.96-1.77), a 52% higher 1-year risk of death (HR 1.52, 95% CI 1.23-1.89), and a 44% higher 2-year mortality risk (HR 1.50, 95% CI 1.17-1.77).

“Acute myocardial infarction continues to remain an important and highly prevalent complication of diabetes,” wrote Jain et al. “Effective disease management as well as optimal and timely use of guideline-directed medical therapies can help curb the excess burden of preventable mortality.”

Reference: Jain V, Qamar A, Matsushita K, et al. Impact of diabetes on outcomes in patients hospitalized with acute myocardial infarction: Insights from the Atherosclerosis Risk in Communities study community surveillance. J Am Heart Assoc. 2023;12:e028923.