Korean Circ J.  2018 Feb;48(2):134-147. 10.4070/kcj.2017.0174.

Long-term Prognosis and Clinical Characteristics of Patients with Newly Diagnosed Diabetes Mellitus Detected after First Acute Myocardial Infarction: from KAMIR-NIH Registry

• Park HW
• Kang MG
• Kim K
• Koh JS
• Park JR
• Jeong YH
• Ahn JH
• Jang JY
• Kwak CH
• Park Y
• Jeong MH
• Kim YJ
• Cho MC
• Kim CJ
• Hwang JY
• on behalf of the KAMIR-NIH registry

• KMID: 2403161
• DOI: http://doi.org/10.4070/kcj.2017.0174

Abstract

BACKGROUND AND OBJECTIVES
After the first acute myocardial infarction (AMI), a considerable proportion of patients are newly diagnosed with diabetes mellitus (DM). However, in AMI, controversy remains regarding the disparity in prognosis between previously diagnosed DM (known-DM) and newly diagnosed DM (new-DM).
METHODS
The study included 10,455 patients with AMI (non-DM, 6,236; new-DM, 659; known-DM, 3,560) admitted to one of 15 participating centers in Korea between November 2011 and January 2016 (average follow-up, 523 days). We compared the characteristics and clinical course of patients with known-DM and those with new- or non-DM.
RESULTS
Compared to patients with known-DM, those with new-DM or non-DM were younger, more likely to be male, and less likely to have hypertension, dyslipidemia, prior stroke, angina, or myocardial infarction. Compared to patients with new-DM or non-DM (reference), those with known-DM had higher risks of major adverse cardiac events (hazard ratio [HR], 1.20; 95% confidence interval [CI], 1.06-1.35; p=0.004), cardiac death (HR, 1.26; 95% CI, 1.01-1.57; p=0.042), and congestive heart failure (HR, 1.58; 95% CI, 1.20-2.08). Unlike known-DM, new-DM did not increase the risk of cardiac events (including death).
CONCLUSIONS
Known-DM was associated with a significantly higher risk of cardiovascular events after AMI, while new-DM had a similar risk of cardiac events as that noted for non-DM. There were different cardiovascular outcomes according to diabetes status in patients with AMI.

Keyword

Diabetes mellitus; Myocardial infarction; Cardiac death; Congestive heart failure

MeSH Terms

Death
Diabetes Mellitus*
Dyslipidemias
Follow-Up Studies
Heart Failure
Humans
Hypertension
Korea
Male
Myocardial Infarction*
Prognosis*
Stroke

Figure

• 

  Figure 1 Study scheme. From nation-wide multicenter registries, 12,375 patients with myocardial infarction were analyzed in this study. CAG = coronary angiography; DM = diabetes mellitus; HbA1c = glycated hemoglobin; known-DM = previously diagnosed diabetes mellitus; new-DM = newly diagnosed diabetes mellitus; STEMI = ST-segment elevation myocardial infarction.

• 

  Figure 2 Long-term clinical outcomes after AMI. Patients were stratified according to DM status at admission for AMI: non-DM, DM not diagnosed at the time of admission for AMI; known-DM, DM diagnosed prior to admission for AMI; new-DM, DM diagnosed at admission for AMI. AMI = acute myocardial infarction; CHF = congestive heart failure; DM = diabetes mellitus; known-DM = previously diagnosed diabetes mellitus; MACE = major adverse cardiac event; new-DM = newly diagnosed diabetes mellitus; re-AMI = recurrent acute myocardial infarction; re-PCI = revascularization via repeat percutaneous coronary intervention. *p<0.05 vs. non-DM, †p<0.05 for known-DM vs. new-DM.

• 

  Figure 3 Kaplan-Meier curves for survival free of adverse events and reintervention after AMI. (A) Cumulative incidence of MACEs, (B) cardiac mortality, (C) re-AMI, (D) re-PCI, and (E) hospitalization related to CHF. AMI = acute myocardial infarction; CHF = congestive heart failure; DM = diabetes mellitus; known-DM = previously diagnosed diabetes mellitus; MACE = major adverse cardiovascular event; new-DM = newly diagnosed diabetes mellitus; re-AMI = recurrent acute myocardial infarction; re-PCI = revascularization via repeat percutaneous coronary intervention.

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