title: The influence of diabetes on in-hospital and long-term mortality in patients with myocardial infarction complicated by cardiogenic shock: results from the PL-ACS registry.
abstract: BACKGROUND
  Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM).
  
  
  OBJECTIVE
  To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group.
  
  
  METHODS
  71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM.
  
  
  RESULTS
  The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02).
  
  
  CONCLUSIONS
  Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.
authors.affiliation: Department of Cardiology, Medical University of Silesia, Silesian Centre for Heart Diseases, ul. M. Curie-Skłodowskiej 9, Zabrze, Poland. m.gasior@op.pl
authors.forename: Mariusz
authors.initials: M
authors.lastname: Gąsior
authors.forename: Damian
authors.initials: D
authors.lastname: Pres
authors.forename: Marek
authors.initials: M
authors.lastname: Gierlotka
authors.forename: Michał
authors.initials: M
authors.lastname: Hawranek
authors.forename: Grzegorz
authors.initials: G
authors.lastname: Słonka
authors.forename: Andrzej
authors.initials: A
authors.lastname: Lekston
authors.forename: Paweł
authors.initials: P
authors.lastname: Buszman
authors.forename: Zbigniew
authors.initials: Z
authors.lastname: Kalarus
authors.forename: Marian
authors.initials: M
authors.lastname: Zembala
authors.forename: Lech
authors.initials: L
authors.lastname: Poloński
mesh_terms: D000368:Aged; D015897:Comorbidity; D003327:Coronary Disease / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D006973:Hypertension / Q000453:epidemiology; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000401:mortality*; D009765:Obesity / Q000453:epidemiology; D011379:Prognosis; D012042:Registries; D017678:Sex Distribution; D012737:Sex Factors; D012770:Shock, Cardiogenic / Q000401:mortality* / Q000628:therapy; D015996:Survival Rate