Long-Term Prognostic Importance of Diabetes After a Myocardial Infarction Depends on Left Ventricular Systolic Function

Abstract

OBJECTIVEThis study was performed to understand how left ventricular function modulates the prognostic importance of diabetes after myocardial infarction (MI).RESEARCH DESIGN AND METHODSConsecutively hospitalized MI patients screened for three clinical trials were followed for a median of 7 years. Multivariable Cox regression models were used to assess the risk of mortality associated with diabetes, and the importance of diabetes was examined independently within defined left ventricular ejection fraction (LVEF) subgroups.RESULTSA total of 16,912 patients were included; 1,819 (11%) had diabetes. Diabetes and 15% unit depression in LVEF were of similar prognostic importance: hazard ratios (HRs) were 1.45 (95% CI 1.37–1.54) and 1.41 (1.37–1.45) for diabetes and LVEF depression, respectively. LVEF modified the outcomes associated with diabetes, with HRs being 1.29 (1.19–1.40) and 1.61 (1.49–1.74) in patients with LVEF <40% and LVEF ≥40%, respectively (P = 0.03).CONCLUSIONSPatients within the higher LVEF categories have a greater mortality risk attributable to diabetes than patients within the lower LVEF categories.

Long‐term mortality after acute myocardial infarction among individuals with and without diabetes: A systematic review and meta‐analysis of studies in the post‐reperfusion era

“…A total of 65 articles, reporting data on 66 cohorts (10 RCTs and 56 non‐RCT) were eligible for the meta‐analysis (Figure ). Data on an estimated 202 411 deaths in 714 780 individuals, over the median (range) follow‐up of 2.0 (1‐20) years were reported …”

“…Adjusted analysis for the outcome of long-term mortality was reported in 23/66 studies. 4,5,7,[25][26][27]29,32,40,41,43,48,51,52,54,56,58,59,61,66,67,76 Ascertainment of diagnosis of diabetes varied across the studies, and was based on self-reporting/admission records/physician-ascertainment (52/66), plus new diagnosis during the admission established using routine glucose measurement (13/66), and information in the discharge records (Table S2, File S1). There were 57 034 deaths in 155 526 participants with diabetes (36.7%) compared with 145 377 deaths in 559 254 participants (26.0%) without diabetes (P < .00001).…”

A history of diabetes predicts outcomes following myocardial infarction: an analysis of the 28 771 patients in the High‐Risk MI Database

“…Earlier reports have also looked at the risk‐modifying properties of diabetes following MI in populations from studies that were conducted in the decades prior to the trials in the common database . However, this was a time‐frame when patients did not benefit from several aspects of modern post‐MI management.…”

Association of Clopidogrel Treatment With Risk of Mortality and Cardiovascular Events Following Myocardial Infarction in Patients With and Without Diabetes

“…[1][2][3][4] Some of this increase in risk may relate to platelet hyperreactivity and altered platelet receptor-and intracellularsignaling pathways; including an upregulation of the P2Y 12 pathway seen in patients with diabetes. 5 The P2Y 12 pathway is the therapeutic target used for inhibition of platelet activation in clopidogrel treatment.…”