Diabetes mellitus and cardiogenic shock in acute myocardial infarction

Abstract

Aims: Cardiogenic shock is the leading cause of in-hospital mortality after acute myocardial infarction (MI).This study investigates the importance of age and preexisting diabetes mellitus on the incidence and prognosis of cardiogenic shock in a large group of consecutive patients with MI. Methods and results: Baseline characteristics and in-hospital complications to the infarction were prospectively recorded in 6676 patients with MI.Ten-year mortality was collected. Diabetes was present in 10.8% of the total population. A total of 443 developed cardiogenic shock with an incidence of 6.2% among nondiabetics and 10.6% among diabetics. Age, wall motion index, reinfarction, and the absence of thrombolytic treatment were significant independent predictors of mortality in patients with cardiogenic shock. Intriguingly, diabetes was not a significant predictor for short-and long-term mortality in this population. The 30-day and 5-year mortality rate was equally poor in both diabetic and nondiabetic patients with cardiogenic shock (diabetics: 30-day 63%, 5-year 91%; nondiabetics: 30-day 62%, 5-year 86%; pN0.05). Conclusions: Cardiogenic shock develops approximately twice as often among diabetics as among nondiabetic patients with acute MI. The prognosis of diabetics with cardiogenic shock is similar to the prognosis of nondiabetic patients with cardiogenic shock.

Cardiogenic shock as a first presentation in acute myocardial infarction in Egyptian's patients and its outcome

“…These results are in agreement with that reported by Lindholm [5] who reported that, the mean age of cases with CS was 74 compared to 69 in cases with acute MI only.…”

“…These findings agree with the results of Lindholm et al [5] who reported that males represent 67% of all cases with acute MI and represent 68% of cases with CS compared to 60% of cases without CS. This difference was statistically significant.…”

“…This finding is supported with the study of Lindholm et al [5] who reported that, among the classical risk factors in relation to ischemic heart disease, diabetes, angina and previous myocardial infarction were more common in the group of patients with cardiogenic shock. In addition, a history of heart failure was twice as prevalent among the shock patients.…”

“…They reported that, in a study sample of 13,663 residents hospitalized with AMI 6.6% (n=905) developed cardiogenic shock. In addition, Lindholm et al [5] reported that, cardiogenic shock was present in 444 patients, corresponding to an incidence of 6.7%.…”

“…Risk factors for development of CS in the context of MI include older age, anterior MI, hypertension, diabetes mellitus, multivessel coronary artery disease, prior MI or angina, prior diagnosis of heart failure, STEMI, and left bundle-branch block. There may be clues to impending shock: heart rate is higher and blood pressure lower on hospital presentation among patients who develop CS after admission [5].…”