title: Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR).
abstract: Patients with diabetes mellitus (DM) presenting with acute myocardial infarction (AMI) have worse outcomes versus those without DM. Comparative contemporary data in patients presenting with AMI with insulin-requiring diabetes mellitus (IRDM), noninsulin-requiring diabetes mellitus (NIRDM), and newly identified DM (hemoglobin A1C level >6.5%) versus patients without DM are limited. This observational study from the National Cardiovascular Data Registry (NCDR) Acute Coronary Treatment and Intervention Outcomes Network-Get with the Guidelines (ACTION Registry-GWTG consisted of 243,861 patients with AMI from 462 US sites identified from January 2007 to March 2011 entered into the registry. Clinical characteristics, management, and in-hospital outcomes were analyzed. Patients with DM with non-ST-segment elevation myocardial infarction (NSTEMI; n = 53,094, 35%) were less likely to undergo diagnostic angiography or revascularization, whereas those with ST-segment elevation myocardial infarction (STEMI) (n = 21,507, 23%) were less likely to undergo reperfusion therapy compared with patients without DM. There was an increased adjusted risk of in-hospital mortality in the DM group in both the NSTEMI (odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06 to 1.22) and STEMI (OR 1.17, 95% CI 1.07 to 1.27) population. In patients with DM, the risk-adjusted in-hospital mortality was higher in patients with IRDM than those with NIRDM in the NSTEMI group (OR 1.12, 95% CI 1.01 to 1.24) but not in the STEMI group (OR 1.12, 95% CI 0.95 to 1.32). Newly diagnosed patients with DM presenting with AMI had similar unadjusted in-hospital outcomes compared with patients without DM. In conclusion, patients with DM presenting with AMI have a higher mortality risk than patients without DM. In patients with DM, those with IRDM presenting with NSTEMI had an increased mortality than those with NIRDM.
authors.affiliation: Section of Cardiovascular Disease, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Talla A
authors.initials: TA
authors.lastname: Rousan
authors.affiliation: Section of Cardiovascular Disease, Department of Internal Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
authors.forename: Reji M
authors.initials: RM
authors.lastname: Pappy
authors.affiliation: Department of Biostatistics, Duke Clinical Research Institution, Durham, North Carolina.
authors.forename: Anita Y
authors.initials: AY
authors.lastname: Chen
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Duke Clinical Research Institution, Durham, North Carolina.
authors.forename: Matthew T
authors.initials: MT
authors.lastname: Roe
authors.affiliation: Division of Cardiology, Department of Medicine, Northshore University Health System, Evanston, Illinois. Electronic address: jsaucedo@northshore.org.
authors.forename: Jorge F
authors.initials: JF
authors.lastname: Saucedo
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003922:Diabetes Mellitus, Type 1 / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications* / Q000453:epidemiology; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006442:Glycated Hemoglobin / Q000378:metabolism; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D009017:Morbidity / Q000639:trends; D009203:Myocardial Infarction / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate / Q000639:trends; D014481:United States / Q000453:epidemiology
chemical_list: D006442:Glycated Hemoglobin