Comparison of clinical outcomes and left ventricular remodeling after ST-elevation myocardial infarction between patients with and without diabetes mellitus

Abstract

Left ventricular remodeling (LVR) after ST-elevation myocardial infarction (STEMI) is generally thought to be an adaptive but compromising phenomenon particularly in patients with diabetes mellitus (DM). However, whether the extent of LVR is associated with poor prognostic outcome with or without DM after STEMI in the modern era of reperfusion therapy has not been elucidated. This was a single-center retrospective observational study. Altogether, 243 patients who were diagnosed as having STEMI between January 2016 and March 2019, and examined with echocardiography at baseline (at the time of index admission) and mid-term (from 6 to 11 months after index admission) follow-up were included and divided into the DM (n = 98) and non-DM groups (n = 145). The primary outcome was major adverse cardiovascular events (MACEs) defined as the composite of all-cause death, heart failure (HF) hospitalization, and non-fatal myocardial infarction. The median follow-up duration was 621 days (interquartile range: 304–963 days). The DM group was significantly increased the rate of MACEs (P = 0.020) and HF hospitalization (P = 0.037) compared with the non-DM group, despite of less LVR. Multivariate Cox regression analyses revealed that the patients with DM after STEMI were significantly associated with MACEs (Hazard ratio [HR] 2.79, 95% confidence interval [CI] 1.20–6.47, P = 0.017) and HF hospitalization (HR 3.62, 95% CI 1.19–11.02, P = 0.023) after controlling known clinical risk factors. LVR were also significantly associated with MACEs (HR 2.44, 95% CI 1.03–5.78, P = 0.044) and HF hospitalization (HR 3.76, 95% CI 1.15–12.32, P = 0.029). The patients with both DM and LVR had worse clinical outcomes including MACEs and HF hospitalization, suggesting that it is particularly critical to minimize LVR after STEMI in patients with DM.

Three-dimensional echocardiographic assessment of left ventricular geometric changes following acute myocardial infarction

“…Previous studies demonstrated that adverse remodeling was associated with increased incidence of HF [ 2 , 28 ] as well as overall MACE [ 29 ]. In a prospective cohort of 285 patients with STEMI who underwent revascularization, developing adverse LV remodeling at 6 months, defined as ≥ 12% increase in both LVESV and LVEDV by CMR, was associated with higher 5-year composite of all-cause death and HF hospitalization [ 30 ].…”

Clinical outcomes guided by quantitative flow ratio in multivessel disease and ST-elevation myocardial infarction patients with diabetes mellitus

“…In terms of quantity, some reports showed the ratio of 2-vessel disease in STEMI patients with DM was similar with nonDM (36% vs 35%, P = 0.809), but 3-vessel disease was different obviously (29% vs 23%, P = 0.121) [19]. Other study showed 2-vessel disease (31.6% vs 27.6%, P not displayed) and 3-vessel disease (24.5% vs 15.2%, P not displayed) of STEMI + DM patients were similar with patients with nonDM [20]. Another study showed 2-vessel disease (31.0% vs 28.0%, P not displayed) and 3-vessel disease (28.0% vs 16.0%, P not displayed) of STEMI + DM patients were higher than that of nonDM [21].…”

“…In terms of complexity, baseline SS of STEMI + DM patients was higher than nonDM patients (18.0 ± 11.5 vs 15.0 ± 12.5, P = 0.013) in Burgess et al study [20]. MVD-STEMI + DM patients are more severe than STEMI + DM patients, but there are no reports on the speci c situation of SYNTAX score.…”

“…In a large regional program, STEMI patients with DM had higher rates of 5-year all-cause mortality (16% vs 9%, P < 0.001) when compared to that without DM [27]. Likewise, another trial showed 3.6-year primary endpoint (27% vs 18%, P = 0.042) including cardiac death (12% vs 4%, P = 0.001), myocardial infarction (14% vs 13%, P = 0.581), and cardiovascular accident (7% vs 5%, P = 0.124) had a higher incidence in STEMI patients with DM than those without DM [20]. Our research revealed the MACE occurred in 22.9% MVD-STEMI patients with DM vs 13.6% with nonDM (P = 0.002).…”

Plasma hsa-miR-22-3p Might Serve as an Early Predictor of Ventricular Function Recovery after ST-Elevation Acute Myocardial Infarction

“…Although we found no correlation between plasma miR-22 and glycemia, the diabetic status per se impacts the ability of miR-22 to discriminate between aMI patients and controls. In patients with HF and aMI, DM was shown to influence LVR and LV dynamics, with a consecutive impact on their cardiovascular outcome [ 44 , 45 ]. Of note, in these patients, HbA1c values correlate negatively with the LVEF and strongly predict both short- and long-term complications [ 46 , 47 , 48 ].…”