National Trends over One Decade in Hospitalization for Acute Myocardial Infarction among Spanish Adults with Type 2 Diabetes: Cumulative Incidence, Outcomes and Use of Percutaneous Coronary Intervention

Abstract

BackgroundThis study aims to describe trends in the rate of acute myocardial infarction (AMI) and use of percutaneous coronary interventions (PCI) in patients with and without type 2 diabetes in Spain, 2001–2010.MethodsWe selected all patients with a discharge of AMI using national hospital discharge data. Discharges were grouped by diabetes status: type 2 diabetes and no diabetes. In both groups PCIs were identified. The cumulative incidence of discharges attributed to AMI were calculated overall and stratified by diabetes status and year. We calculated length of stay and in-hospital mortality (IHM). Use of PCI was calculated stratified by diabetes status. Multivariate analysis was adjusted by age, sex, year and comorbidity. Results: From 2001 to 2010, 513,517 discharges with AMI were identified (30.3% with type 2 diabetes). The cumulative incidence of discharges due to AMI in diabetics patients increased (56.3 in 2001 to 71 cases per 100,000 in 2004), then decreased to 61.9 in 2010. Diabetic patients had significantly higher IHM (OR, 1.14; 95%CI, 1.05–1.17). The proportion of diabetic patients that underwent PCI increased from 11.9% in 2001 to 41.6% in 2010. Adjusted incidence of discharge in patients with diabetes who underwent PCI increased significantly (IRR, 3.49; 95%CI, 3.30–3.69). The IHM among diabetics patients who underwent a PCI did not change significantly over time.ConclusionsAMI hospitalization rates increased initially but declining slowly. From 2001 to 2010 the proportion of diabetic patients who undergo a PCI increased almost four-fold. Older age and more comorbidity may explain why IHM did not improve after a PCI.

Impact of type 2 diabetes mellitus on in-hospital-mortality after major cardiovascular events in Spain (2002–2014)

“…Using the National Inpatient Sample, Ahmed et al, obtained an adjusted OR of 1.069, (95% CI 1.051–1.087) for DM on in-hospital mortality in patients with an acute myocardial infarction [ 31 ]. It is reassuring that in previous research from our group, without proceeding with case–control matching and evaluating a different period of time (2001–2010), the IHM that we reported was 14% higher in people with T2DM compared with no-diabetes in people admitted for a myocardial infarction [ 5 ], which is very similar to current data. Also, we had formerly reported a 7% significantly higher mortality for women with T2DM admitted for ischemic stroke versus non-diabetic women, yet no statistical differences for men [ 6 ], or for any gender when comparing T2DM and non-diabetic patients admitted for hemorrhagic stroke [ 32 ].…”

“…This may underlie the fact that in the United States the adjusted incidence rates of hospital admissions for acute myocardial infarction or fatal coronary artery disease have decreased in recent years [ 4 ]. We have previously reported increasing incidence rates overtime of acute myocardial infarction [ 5 ], ischemic stroke [ 6 ] and admissions for abdominal aortic aneurysm [ 7 ], but declining rates of major lower extremity amputations due to peripheral artery disease for the overall population [ 8 ]. Moreover, incidence rates of major cardiovascular events are higher in people with type 2 diabetes mellitus (T2DM) than among people without diabetes in our Mediterranean population.…”

A systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction

“…Table 1 shows the characteristics of the 110 included studies. Twelve studies [2,[7][8][9]39,63,72,73,93,100,103,106] reported N 1 cohort of patients which in this case were abstracted separately leading to 139 studies/cohorts for statistical analysis. The median inclusion year varied from 1970 to 2011, and the number of patients per study from 255 to 160,773.…”

Suppression of Excessive Histone Deacetylases Activity in Diabetic Hearts Attenuates Myocardial Ischemia/Reperfusion Injury via Mitochondria Apoptosis Pathway

“…Epidemiological surveys indicated that diabetic patients are more likely to develop cardiovascular complications [ 19 ]. Despite current optimal therapy, the mortality rate of acute myocardial infarction in diabetic patients is more than double that of nondiabetic patients [ 20 ].…”