Diabetes mellitus is not independently associated with mortality in elderly patients with ST-segment elevation myocardial infarction. Insights from the Codi Infart registry. Issue 1 (January 2020)

• Record Type: Journal Article
• Authors: Gual, Miquel; Ariza-Solé, Albert; Formiga, Francesc; Carrillo, Xavier; Bañeras, Jordi; Tizón, Helena; Garcia-Picart, Joan; Cárdenas, Mérida; Regueiro, Ander; Tomás, Carlos; Rojas, Sergio; Muñoz-Camacho, Juan F.; Rosas, Alba; Sánchez-Salado, José C.; Lorente, Victòria; Roura, Gerard; Alegre, Oriol; Gómez-Hospital, Joan A.; Lidón, Rosa M; Cequier, Angel
• Is Part Of: Coronary artery disease. Volume 31:Issue 1(2020:Jan.)
• Publication Date: 2020-01
• Subjects: diabetes mellitus -- elderly -- mortality -- ST-segment elevation myocardial infarction; Coronary heart disease -- Periodicals; Coronary Disease -- Indexes; Coronary Disease -- Periodicals; 616.123005
• DOI: 10.1097/MCA.0000000000000821
• Languages: English
• ISSNs: 0954-6928

Abstract

Abstract : Background: Diabetes mellitus predicts poorer outcomes in patients with acute coronary syndrome (ACS), but the magnitude of this association in patients at older ages remains controversial. Methods: Data were extracted from the Codi Infart database. All consecutive patients with diagnosis of ST-segment elevation myocardial infarction (STEMI) undergoing primary percutaneous coronary intervention (PCI) between 2010 and 2015 were included. We assessed the impact of diabetes mellitus on 30-day and one-year mortality in patients aged less than and at least 75 years. Results: A total of 12 792 cases were registered, of whom 3023 (23.6%) were aged at least 75 years. About 20% patients had previous diabetes mellitus diagnosis. Patients aged at least 75 years had higher prevalence of comorbidities, higher proportion of heart failure at admission, a more extensive coronary artery disease and significant delay to reperfusion ( P < 0.001). Diabetes mellitus was associated with higher 30-day mortality both in young [odds ratio (OR) 1.97, 95% confidence interval (CI): 1.43–2.70] and in elderly patients (OR 1.43, 95% CI: 1.07–1.91). After adjusting for potential confounders, this association remained significant in young patients (OR 1.47, 95% CI: 1.00–2.16, P = 0.047), but not in the elderly (OR 1.14, P = 0.43). Likewise, a crude association between diabetes mellitus and one-year mortality was observed in both groups (young patients: HR = 1.93; 95% CI: 1.51–2.46; older patients: HR = 1.33; 95% CI: 1.08–1.64). However, after adjusting for potential confounders, this association remained significant in younger patients (HR = 1.46; 95% CI: 1.13–1.89; P < 0.001), but not in the elderly (HR = 1.16; P = 0.17). Conclusion: A significant proportion of these nonselected patients with STEMI had previous diabetes mellitus. The association between diabetes mellitus and outcomes is different according to age.