Impact of Diabetes on Outcomes in Patients Hospitalized With Acute Myocardial Infarction: Insights From the Atherosclerosis Risk in Communities Study Community Surveillance

• Type of Material: Article
• Authors: Vardhmaan Jain, Emory University; Arman Qamar, NorthShore University Health System; Kunihiro Matsushita, Johns Hopkins University; Muthiah Vaduganathan, Brigham and Women’s Hospital; Kellan E Ashley, University of Mississippi; Muhammad Shahzeb Khan, Duke University; Deepak L Bhatt, Icahn Sch Med Mt Sinai Hlth Syst; Sameer Arora, University of North Carolina; Melissa C Caughey, University of North Carolina
• Language: English
• Date: 2023-05-16
• Publisher: WILEY
• Publication Version: Final Published Version
• Copyright Statement: © 2023 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1161/JAHA.122.028923
• Title of Journal or Parent Work: JOURNAL OF THE AMERICAN HEART ASSOCIATION
• Volume: 12
• Issue: 10
• Start Page: e028923
• End Page: e028923
• Grant/Funding Information: The Atherosclerosis Risk in Communities study has been funded in whole or in part with federal funds from the National Heart, Lung, and Blood Institute, National Institutes of Health, Department of Health and Human Services (contract numbers HHSN268201700001I, HHSN268201700002I, HHSN268201700003I, HHSN268201700004I, and HHSN268201700005I).
• Keywords: epidemiology; ST-SEGMENT ELEVATION; Life Sciences & Biomedicine; Science & Technology; CORONARY-ARTERY-DISEASE; GUIDELINES; diabetes; TRENDS; Cardiovascular System & Cardiology; Cardiac & Cardiovascular Systems; MELLITUS; COMPLICATIONS; myocardial infarction; outcomes; REVASCULARIZATION
• Research Categories: Health Sciences, Medicine and Surgery; Engineering, Biomedical

Abstract

BACKGROUND: Diabetes is associated with increased risk of acute myocardial infarction (AMI). The demographic trends, clinical presentation, management, and outcomes of patients with diabetes who are hospitalized with AMI have not been recently reported. METHODS AND RESULTS: The ARIC (Atherosclerosis Risk in Communities) study conducted hospital surveillance of AMI in 4 US communities. AMI was classified by physician review using a validated algorithm. Medications and procedures were abstracted from the medical record. From 2000 to 2014, 21 094 weighted hospitalizations for AMI were sampled. The prevalence of diabetes steadily increased, from 35% to 41% to 43% (P-trend<0.0001) across 2000 to 2004, 2005 to 2009, and 2010 to 2014, respectively. Patients with diabetes were older (61 versus 59 years of age), more often Black (44% versus 31%), and more commonly women (42% versus 34%). The burden of cardiovascular comorbidities was higher with diabetes and increased temporally. Patients with diabetes less often presented with ST-segment elevation (9% versus 17%) or acute chest pain (72% versus 80%), and had higher mean GRACE (Global Registry of Acute Coronary Syndrome) score (123 versus 109), Thrombolysis in Myocardial Ischemia (TIMI) score (4.3 versus 4.0), and Killip class (1.9 versus 1.5). Patients with diabetes had a lower adjusted probability of receiving aspirin (relative probability, 0.95 [95% CI, 0.91– 0.99]), nonaspirin antiplatelets (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]). Diabetes was associated with a 52% higher hazard of all-cause 1-year mortality (hazard ratio, 1.52 [95% CI, 1.23–1.89]). CONCLUSIONS: Diabetes is associated with higher risk of death in patients hospitalized with AMI, highlighting the need for ad-herence to evidence-based therapies in this high-risk population.