Patients with Diabetes at Risk for In-Hospital Mortality from MI

Chicago—An extensive analysis of hospital records found that patients with acute myocardial infarction (MI) and diabetes were more likely to have in-hospital mortality, recurrent MI, stroke, and congestive heart failure compared with patients with acute MI who did not have diabetes. Results were presented during a poster session at the ACC meeting. The poster was titled Diabetes Is a Risk Factor for In-Hospital Mortality and Recurrent Myocardial Infarction: Analysis of National Registry of Myocardial Infarction 4-5. The authors noted that patients with diabetes are at an increased risk of cardiovascular disease (CV) disease; diabetes is found in an estimated 11.3% of people in the United States who are ≥20 years of age. Still, they said much is unknown about how diabetes affects in-hospital CV mortality and morbidity in patients with acute MI. To determine the association between diabetes and acute MI, the authors examined the National Registry of Myocardial Infarction, which included 850,641 patients from 1304 hospitals. They excluded patients who were transferred to other hospitals as well as those who did not have a primary discharge diagnosis of acute MI. In all, the study included 232,927 patients discharged from 823 hospitals between July 2002 and December 2006; 31% had diabetes. Of the patients with diabetes, 31.3% previously had an MI compared with 21.8% who did not have diabetes. Compared with patients who did not have diabetes, those with diabetes had higher rates of previous hypertension, hypercholesterolemia, angina, stroke, and percutaneous coronary intervention (P<.001 for all comparisons). The analysis found that patients with diabetes were at an increased risk of in-hospital mortality (odds ratio [OR], 1.18; 95% confidence interval [CI], 1.13-1.23), in-hospital recurrent MI (OR, 1.14; 95% CI, 1.05-1.24), and in-hospital stroke (OR, 1.30; 95% CI, 1.19-1.43). In addition, patients were at an increased risk of congestive heart failure if they had a prior MI (OR, 1.37; 95% CI, 1.33-1.42) and if they had no prior MI (OR, 1.57; 95% CI, 1.50-1.64). Patients with diabetes and prior MI remained in the hospital approximately 20 hours longer than those without diabetes but a prior MI. Patients with diabetes but no prior MI remained in the hospital approximately 14 hours longer than those without diabetes but a prior MI. The authors concluded that although patients with diabetes are well known as a high-risk population, there were low rates of medication therapy for CV disease among that population in this study. They wrote that the results “highlight the need for improved medical management and new treatment options to prevent adverse CV events in patients with diabetes and acute MI.” Study limitations cited included a lack of data about clinical features during the time of presentation and in-hospital treatment options after the initial presentation.