The investigators analyzed the prevalence of diabetes and related clinical outcomes in patients aged 55 years and younger with AMI and compared the baseline characteristics and clinical outcomes of diabetic and non-diabetic patients with AMI by age.
Data were obtained from the Korea Acute Myocardial Infarction Registry–National Institutes of Health database. Patients with AMI were enrolled at 20 major percutaneous coronary intervention centers in Korea from November 2011 to December 2015.
The overall cohort included 12,600 patients. The “young” group (age ≤55 years) included 3,590 participants, of whom 953 (mean age, 48.6±5.2 years; 9.0% women) had diabetes and 2,637 (mean age, 47.9 ±5.7 years; 6.6% women) no. have diabetes. The “elderly” (>55 years) group included 9010 patients, of which 3341 (mean age, 69.7±8.2 years; 36% women) had diabetes and 5669 (mean age, 69.9±8 years, 9 years; 31% women) no. 🇧🇷
The primary outcome was all-cause mortality at 3 years. The cohort had an overall DM prevalence of 34.1% and 19.7% of participants were diagnosed with diabetes at initial admission.
Among all participants, all-cause mortality (12.6% vs 6.8%; adjusted hazard ratio [HR], 1.32; 95% CI, 1.14-1.53; P <0.001), cardiac mortality (6.6% vs 3.4%; adjusted HR, 1.29 [1.05-1.59]🇧🇷 P =0.016), recurrent myocardial infarction (5.1% vs 3.0%; adjusted HR, 1.38 [1.13-1.69]🇧🇷 P =0.002) and major adverse cardiac events (19.8% vs 11.6%; adjusted HR, 1.17 [1.05-1.31]🇧🇷 P =0.005) were significantly higher in patients with DM compared to patients without DM, respectively, during follow-up.
Diabetes was strongly associated with long-term all-cause mortality in both age groups after multivariate adjustment, especially in the youth group.P value for the interaction between age and diabetes =.008). Patients with diabetes had a 107% higher risk of 3-year mortality compared to those without diabetes if they were 55 years or younger. Patients with diabetes had a 25% higher risk of all-cause mortality at 3 years compared with those without diabetes if they were 55 years or older after adjustment.
In the analysis using age as a continuous variable, similar results were observed, with P value of 0.003 for the interaction between age and diabetes in the multivariate model adjusted for all-cause mortality. Similar findings were found for cardiac mortality and major adverse cardiovascular events.
Study limitations include the retrospective design, and data were limited on diabetes duration, treatment, severity, management, and complications. In addition, there was heterogeneity in laboratory parameters and clinical practice, which may have affected clinical results.
“This study emphasizes that diabetes is not uncommon in young patients with AMI, and the adjusted risk of all-cause mortality as a result of diabetes is markedly higher in younger patients,” the researchers wrote. “These findings highlight the need for a major research effort to identify new aggressive strategies for managing AMI and preventing post-AMI adverse cardiovascular events, especially in young diabetic patients.”
Song PS, Ahn KT, Kim MJ and others. Age-related difference in the impact of diabetes mellitus on all-cause mortality after acute myocardial infarction. Diabetes Metab🇧🇷 Published online April 20, 2022. doi:10.1016/j.diabet.2022.101349