Long-Term Outcomes of STEMI Patients with Diabetes Mellitus: Insights from the Midwest STEMI Consortium
Presenter
Michael S Megaly, M.D., FSCAI, St John Hospital & Medical Center, Tulsa, OK
Michael S Megaly, M.D., FSCAI1, Christian Schmidt, MS2, Marshall Dworak, BA2, Ross Garberich, MS, MBA3, Larissa Stanberry, PhD4, Scott W. Sharkey, M.D.5, Emmanouil S. Brilakis, MD, PhD, FSCAI6, Frank V. Aguirre, M.D.7, Roberto Pacheco, MD7, Teresa Coulson8, Timothy D. Smith, M.D., FSCAI9, Timothy D. Henry, M.D., MSCAI10 and Santiago Garcia, MD, FSCAI11, (1)St John Hospital & Medical Center, Tulsa, OK, (2)Minneapolis Heart Institute, Minneapolis, MN, (3)Minneapolis Heart Institute Foundation, Minneapolis, MN, (4)Minneapolis Heart Institute Foundation at Abbott Northwestern Hospital, Minneapolis, MN, (5)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Minneapolis, MN, (6)Minneapolis Heart Institute® - Abbott Northwestern Hospital, Edina, MN, (7)-, Springfield, IL, (8)Iowa Heart Institute, De Moines, IA, (9)OhioHealth Riverside Methodist Hospital, Cincinnati, OH, (10)The Christ Hospital Health Network, Dayton, KY, (11)The Christ Hospital Health Network, Cincinnati, OH
Keywords: Acute Coronary Syndromes (ACS)
Background:
The long-term outcomes of diabetic patients presenting with with ST-segment elevation myocardial infarction (STEMI) in contemporary practice have received limited study.
Methods
:
We evaluated the outcomes of STEMI patients included in the Midwest STEMI consortium, a collaboration of four large regional STEMI programs designed to facilitate timely primary percutaneous coronary intervention (PPCI). The primary and secondary outcome measures were in-hospital mortality, 1- year major adverse cardiovascular events (MACE) (stroke, re-infarction, unplanned PCI or coronary artery bypass graft [CABG] surgery and all-cause mortality), and 5-year mortality.
Results
:
Of the 13,788 patients included in the registry, 2,967 (21.5%) had diabetes mellitus (DM) (95% Type II , 5% Type I) whereas 10,821 did not. Patients with DM were older (mean age 64±14 vs. 62±12 years, p<0.01), had more co-morbidities (previous MI: 30% vs 18%, p <0.001; previous CABG surgery: 13% vs 6%, p<0.01), and were more likely to receive medical therapy without reperfusion (11% vs. 9%, p=0.002). Patients with DM had higher in-hospital (7% vs. 5%, p<0.01), 1-year (8% vs. 4%, p<0.01) and 5-year mortality (18% vs. 10%, p<0.01) compared to non-diabetics. On Cox regression analysis, DM was independently associated with worse 5-year mortality (hazard ratio: 1.61, 95% CI: 1.38- 1.88, p<0.001) and 1-year MACE [hazard ratio (HR): 1.57 (95% confidence interval (CI): 1.31-1.88, p<0.001].
Conclusions:
DM remains independently associated with higher short- and long-term morbidity and mortality in contemporary practice.
