Document Type
Article
Publication Date
2018
College/Unit
School of Medicine
Department/Program/Center
Medicine
Abstract
Background: Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST‐eleva‐ tion myocardial infarction (STEMI). However, the impact of full‐scale decompensated diabetes on STEMI outcomes has not been investigated.
Methods: We utilized the national inpatient sample (2003–2014) to identify adult diabetic patients admitted with STEMI. We defined decompensated diabetes as the presence of diabetic ketoacidosis (DKA) or hyperglycemic hyper‐ osmolar state (HHS). We compared in‐hospital morbidity and mortality and cost between patients with and without diabetes decompensation before and after propensity‐score matching.
Results: A total of 73,722 diabetic patients admitted with STEMI were included in the study. Of those, 1131 (1.5%) suf‐ fered DKA or HSS during the hospitalization. After propensity‐score matching, DKA/HHS remained associated with a significant 32% increase in in‐hospital mortality (25.6% vs. 19.4%, p = 0.001). The DKA/HHS group also had higher inci‐ dences of acute kidney injury (39.4% vs. 18.9%, p < 0.001), sepsis (7.3% vs. 4.9%, p = 0.022), blood transfusion (11.3%
vs. 8.2%) and a non‐significant trend towards higher incidence of stroke (3.8% vs. 2.4%, p = 0.087). Also, DKA/HHS diagnosis was associated with lower rates of referral to coronary angiography (51.5% vs. 55.5%, p = 0.023), coronary stenting (26.1% vs. 34.8%, p < 0.001), or bypass grafting (6.2% vs. 8.7%, p = 0.033). Referral for invasive angiography was associated with lower odds of death during the hospitalization (adjusted OR 0.66, 95%CI 0.44‐0.98, p = 0.039).
Conclusions: Decompensated diabetes complicates ~ 1.5% of STEMI admissions in diabetic patients. It is associated with lower rates of referral for angiography and revascularization, and a negative differential impact on in‐hospital morbidity and mortality and cost.
Digital Commons Citation
Issa, Mayada; Alqahtani, Fahad; Berzingi, Chalak; Al-Hajji, Mohammad; Busu, Tatiana; and Alkhouli, Mohamad, "Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction" (2018). Faculty & Staff Scholarship. 1511.
https://researchrepository.wvu.edu/faculty_publications/1511
Source Citation
Issa, M., Alqahtani, F., Berzingi, C., Al-Hajji, M., Busu, T., & Alkhouli, M. (2018). Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction. Diabetology & Metabolic Syndrome, 10(1). https://doi.org/10.1186/s13098-018-0357-y
Comments
© The Author(s) 2018. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/ publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.