Differential Prognostic Impacts of Diabetes over Time Course after Acute Myocardial Infarction

Abstract

This study was performed to evaluate the effects of diabetes on short- and mid-term clinical outcomes in patients with acute myocardial infarction (AMI). Between October 2005 and December 2009, a total of 22,347 patients with AMI from a nationwide registry was analyzed. At the time point of the day 30 after AMI onset, landmark analyses were performed for the development of major adverse cardiovascular events (MACEs), including death, re-infarction and revascularization. In this cohort, 6,131 patients (27.4%) had diabetes. Short-term MACEs, which occurred within 30 days of AMI onset, were observed in 1,364 patients (6.1%). Among the 30-day survivors (n = 21,604), mid-term MACEs, which occurred between 31 and 365 days after AMI onset, were observed in 1,181 patients (5.4%). After adjustment for potential confounders, diabetes was an independent predictor of mid-term MACEs (HR, 1.25; 95% CI, 1.08-1.45; P = 0.002), but not of short-term MACEs (HR: 1.16; 95% CI: 0.93-1.44; P = 0.167). Diabetes is a poor prognostic factor for mid-term clinical outcomes but not for short-term outcomes in AMI patients. Careful monitoring and intensive care should be considered in diabetic patients, especially following the acute stage of AMI.

Influence of Second- and Third-Degree Heart Block on 30-Day Outcome Following Acute Myocardial Infarction in the Drug-Eluting Stent Era

“…9,10 In brief, the Korea Acute Myocardial Infarction Registry and the Korea Working Group on Myocardial Infarction registry were established in November 2005, with support from the Korean Society of Cardiology, for prospective, open, observational, multicenter studies of AMI, including assessment of clinical outcomes. Fifty-five cardiac centers in Korea participated in establishing the database.…”

The impact of diabetes on electrocardiographic ST resolution and clinical outcome of acute ST elevation myocardial infarction following fibrinolytic therapy

“…The greater burden of the disease in diabetics with myocardial infarction is illustrated by higher prevalence of multi vessel disease [29]. As described before, coronary risk factors are also more prevalent in diabetics [11,20,31]. The combined effects of these factors may be an underlying cause of the poor prognosis in diabetics [20,31].…”

“…As described before, coronary risk factors are also more prevalent in diabetics [11,20,31]. The combined effects of these factors may be an underlying cause of the poor prognosis in diabetics [20,31]. However, the independent impact of diabetes on poor prognosis after myocardial infarction is a matter of controversy [4,11,[20][21][22]31].…”

“…On the other hand, including the patients of clinical trials [18] and using different fi brinolytic medications in some of these studies [14] which may have dissimilar therapeutic responses [9,19], complicates the interpretation and application of the results to a single agent in real-life clinical settings. In addition, there are studies that have reported diminishing adverse impact of diabetes on short-term outcomes after myocardial infarction at least in certain subsets of population, which is attributed partly to the better use of therapeutic methods in diabetics [20,21].…”

AMPK Contributes to Cardioprotective Effects of Pterostilbene Against Myocardial Ischemia- Reperfusion Injury in Diabetic Rats by Suppressing Cardiac Oxidative Stress and Apoptosis

“…These alterations accelerate the susceptibility of the heart muscle to myocardial ischemia-reperfusion (IR) injury [1, 2], resulting in poor clinical prognosis after myocardial infarction [3]. Moreover, diabetic patients have a higher risk of developing myocardial IR than non-diabetic subjects [4].…”