Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries.

Abstract

BACKGROUND:

Diabetes mellitus (DM) predisposes patients to acute myocardial infarction (AMI) and acute heart failure (AHF).

AIMS:

To assess correlates of AHF occurring at the early stage of AMI and synergism between early AHF and DM on 5-year mortality.

METHODS:

FAST-MI 2005 and 2010 included 7839 consecutive patients admitted for AMI.

RESULTS:

Overall, 2151 patients (27.4%) had a history of diabetes mellitus (DM), of whom 629 (29.2%) were on insulin. Patients with versus without DM were older (mean age: 70.0 vs. 64.7years; P<0.001), with more comorbidities and more severe coronary artery disease. Early AHF (pulmonary oedema or cardiogenic shock) was the most frequent in-hospital complication (12.5%) and was twice as frequent in patients with versus without DM (20.2% vs. 9.6%; adjusted odds ratio: 1.66, 95% confidence interval [CI]: 1.43-1.94; P<0.001). Among in-hospital survivors, patients with DM without AHF and those with AHF without DM had 50% increases in 5-year mortality (adjusted hazard ratio [aHR]: 1.50, 95% CI: 1.32-1.69 and aHR: 1.46, 95% CI: 1.23-1.74; both P<0.001) versus patients without DM or AHF; with the risk among those with DM and AHF being doubled (aHR: 1.97, 95% CI: 1.66-2.34; P<0.0001).

CONCLUSION:

Early AHF is the most frequent complication of AMI and is twice as common in patients with versus without DM. After adjustment, early AHF and DM are associated with reduced 5-year survival with synergistic effects in patients with both conditions.

CLINICAL TRIAL REGISTRATION:

https://clinicaltrials.gov (NCT00673036 and NCT01237418).

• Authors: Jean-Guillaume Dillinger, Guy Achkouty, Franck Albert, Grégoire Muller, Jean-Noël Labèque, Louis Moisson, Jean-François Morelle, Yves Cottin, Theo Pezel, Pascal Lim, Nadia Aissaoui, François Schiele, Jean Ferrières, Denis Angoulvant, Patrick Henry, Etienne Puymirat, Tabassome Simon, Nicolas Danchin, FAST-MI investigators
• Journal: Archives of cardiovascular diseases (Arch Cardiovasc Dis) Vol. 115 Issue 5 Pg. 264-275 (May 2022) ISSN: 1875-2128 [Electronic] Netherlands
• PMID: 35304066 (Publication Type: Journal Article)
• Copyright: Copyright © 2022 Elsevier Masson SAS. All rights reserved.

Topics

• Acute Coronary Syndrome (complications, diagnosis, therapy)
• Aged
• Diabetes Mellitus (diagnosis, epidemiology)
• Heart Failure (complications, diagnosis, epidemiology)
• Humans
• Myocardial Infarction
• Prospective Studies
• Registries
• Risk Factors
• Time Factors