Does Diabetes Mellitus Increase the Short- and Long-Term Mortality in Patients With Critical Acute Myocardial Infarction? Results From American MIMIC-III and Chinese CIN Cohorts

Abstract

BackgroundThe harmful effect of diabetes mellitus (DM) on mortality in patients with acute myocardial infarction (AMI) remains controversial. Furthermore, few studies focused on critical AMI patients. We aimed to address whether DM increases short- and long-term mortality in this specific population.MethodsWe analyzed AMI patients admitted into coronary care unit (CCU) with follow-up of ≥1 year from two cohorts (MIMIC-III, Medical Information Mart for Intensive Care III; CIN, Cardiorenal ImprovemeNt Registry) in the United States and China. Main outcome was mortality at 30-day and 1-year following hospitalization. Kaplan-Meier curves and Cox proportional hazards models were constructed to examine the impact of DM on mortality in critical AMI patients.Results1774 critical AMI patients (mean age 69.3 ± 14.3 years, 46.1% had DM) were included from MIMIC-III and 3380 from the CIN cohort (mean age 62.2 ± 12.2 years, 29.3% had DM). In both cohorts, DM group was older and more prevalent in cardio-renal dysfunction than non-DM group. Controlling for confounders, DM group has a significantly higher 30-day mortality (adjusted odds ratio (aOR) (95% CI): 2.71 (1.99-3.73) in MIMIC-III; aOR (95% CI): 9.89 (5.81-17.87) in CIN), and increased 1-year mortality (adjusted hazard ratio (aHR) (95% CI): 1.91 (1.56-2.35) in MIMIC-III; aHR (95% CI): 2.62(1.99-3.45) in CIN) than non-DM group.ConclusionsTaking into account cardio-renal function, critical AMI patients with DM have a higher 30-day mortality and 1-year mortality than non-DM group in both cohorts. Further studies on prevention and management strategies for DM are needed for this population.Clinical Trial Registrationclinicaltrials.gov, NCT04407936.

Sex-specific impact of diabetes on all-cause mortality among adults with acute myocardial infarction: An updated systematic review and meta-analysis, 1988-2021

“…First, we are limited to variables measured and end points published in each study, as with many meta-analyses. Also, many recently published studies related to the topic did not provide sex-specific post-AMI all-cause mortality in both patients with and without diabetes, thus they can’t be included in the review ( 54 – 56 ). Although we followed the PRISMA guidelines and used an extensive search strategy to identify existing literature in multiple databases, the majority of the included studies were observational cohort studies with greater potential for bias and between-study heterogeneity than randomized controlled trials ( 14 ).…”

Acute Myocardiac Infarctions and Type 2 Diabetes Mellitus (T2DM) : a Literature Review

“…Prevalence of DM in AMI patients varied from 20-30% (Arnold, 2014), but it keeps increasing (Gandhi, 2006). Based on a study in 2021 between two cohorts from American and Chinese, the result showed DM is often find in critical AMI patients (almost half and one-third) (Chen, 2021). According to a study in Qatar, as much as 54% prevalence of DM was shown in critical AMI patients (El-Menyar, 2009).…”

“…DM used as a good predictor for prognostic in AMI patients. In patients with AMI, DM contribute to 2 until 9 times higher risk of death (Chen, 2021). During a study in Italy, the death of DM patients with STEMI was also trigger by the predominant factors of the patients who have cardiorenal dysfunction (Marenzi, 2019).…”

Red blood cell distribution width/albumin ratio is a novel risk factor of incidence and long-term mortality in chronic heart failure patients: three large cohorts from China and America

“…All analysis processes were finished with R software (version 4.2.2). In cleaning clinical data, the R packages nhanesR (version 0.9.4.1) were served for NHANES, and pgAdmin PostgreSQL (version 14.1) [20][21][22] was applied in MIMIC.…”