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.

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.

Included in

Cardiology Commons

Share

COinS
 
 

To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.