Effects of delayed hospitalization on the 3‐year clinical outcomes of patients with or without diabetes who had non‐ST‐segment‐elevation myocardial infarction and underwent new‐generation drug‐eluting stent implantation

Abstract

Clinical outcomes after non‐ST‐segment‐elevation myocardial infarction (NSTEMI) in patients with (symptom‐to‐door time [SDT] ≥ 24 h) or without (SDT < 24 h) delayed hospitalization among patients with or without diabetes were compared. From the Korea Acute Myocardial Infarction Registry‐National Institute of Health, a total of 4517 patients with NSTEMI who underwent new‐generation drug‐eluting stents implantation were recruited and they were classified into the diabetes mellitus (DM) and non‐DM groups. These two groups were subdivided into groups with and without delayed hospitalization. The primary clinical outcome was the occurrence of major adverse cardiac and cerebrovascular events (MACCE), defined as all‐cause death, recurrent myocardial infarction, repeat coronary revascularization, and stroke. The secondary clinical outcome was the occurrence of individual components of MACCE and stent thrombosis. Although after multivariable and propensity score‐adjusted analyses in the DM group, the primary and secondary clinical outcomes between the SDT < 24 h and SDT ≥ 24 h groups were similar; in the non‐DM group, all‐cause (p = 0.003 and p = 0.007, respectively) and cardiac (p = 0.001 and p = 0.008, respectively) death rates were significantly higher in the SDT ≥ 24 h group than in the SDT < 24 h group. Our results suggested that there was no significant difference in prognosis between diabetic patients with and without delayed SDT, but delayed SDT was associated with poor prognosis in nondiabetic patients.

Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction

“…Given that HbA1c reflects the cumulative glycemic status of the recent 2–3 months [ 32 ], these observations suggest that the mortality benefits of early presentation seem to be attenuated under the circumstance with poor glycemic control. It seems to be in line with a previously published study, which demonstrated no prognostic difference between patients with diabetes with and without SDT prolongation [ 33 ]. These similarities on all-cause mortality at a higher HbA1c level may be moderately explained by the fact that dysglycemia itself contributes to high rates of adverse cardiovascular outcomes, including mortality [ 34 ], and result in greater infarct sizes [ 34 ].…”