SPC365

Myocardial infarction, diabetes and heart failure: a deadly combination

Session: Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker: Cátia Santos Ferreira

Congress: CPC 2021
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 13. Acute Coronary Syndromes
Subtheme: 13.2 Acute Coronary Syndromes – Epidemiology, Prognosis, Outcome
Session Type: Posters
FP Number: ---
Authors: Cátia Santos Ferreira; Rui Baptista; André Freitas; Sofia Martinho; José Almeida; Gustavo Campos; João Rosa; Silvia Monteiro; Francisco Gonçalves; Pedro Monteiro; Graça Castro; Lino Gonçalves

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">INTRODUCTION: The association between diabetes and heart failure (HF) is well documented, including in patients with coronary artery disease (CAD). However, little is known about the impact of diabetes on the risk of HF in patients with myocardial infarction (MI). Given that this could have important treatment implications, </span></span><span style="font-size:10pt"><span style="font-family:Arial,sans-serif">we aimed to assess the prognostic value of diabetes on the risk of HF and on mortality in <span style="color:black">ST-elevation MI (STEMI).</span></span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">METHODS: We conducted a retrospective, observational cohort study, including all patients with STEMI admitted to and discharged alive from an intensive cardiac care unit between 2004 and 2017 (n=1902). Patients with prior MI were excluded (n=102). The median (interquartile range) follow-up (FU) was 6 (4-10) years. The primary endpoint was hospitalization due to heart failure. The secondary endpoints were non-fatal MI and all-cause mortality.</span></span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">RESULTS: The mean age was 64&plusmn;14 years; 75% were male. Baseline demographics were considerably different in non-diabetic and diabetic patients (Table 1). The risk of developing HF during the index hospitalization was 24.7% among patients with diabetes and 13.6% among those without diabetes (unadjusted </span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">hazard ratio [HR] 2.1; 95%CI 1.6&ndash;2.7; P &lt;0.001). The rates of hospitalization for HF were 5% vs 3% at 1 year, and 15% vs 6% at 10 years for diabetic and non-diabetic patients, respectively. After adjusting for confounders, such as age, sex, hypertension, HF at index hospitalization and left ventricle ejection fraction, diabetic patients were at two-fold higher risk of HF hospitalization than patients without diabetes (HR 2.2; 95%CI 1.4&ndash;3.4; P=0.001). &nbsp;</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Conversely, the rates of non-fatal MI were 3% vs 2% at 1-year, and 13% vs 10% at 10-year for diabetic and non-diabetic patients. However, after adjusting for known confounders, diabetes was not associated with increased risk of MI (HR 1.3; 95%CI 0.9&ndash;1.9; P=0.09).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Among patients who were alive for one year, diabetic patients who had been hospitalized for HF during the first year after STEMI had double the risk of death compared with diabetic patients who had not been hospitalized for HF (10-year mortality 59% vs 34%; HR 2.5; 95%CI 1.6&ndash;3.9; P&lt;0.001). Patients without diabetes who were hospitalized for HF during the first year also had a higher risk of death compared with patients without diabetes and without HF hospitalization (10-year mortality 54% vs 20%; HR 4.2; 95%CI 1.7&ndash;10.1; P&lt;0.001).</span></span></span></span></span></p>

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<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="color:#000000"><span style="font-size:10pt"><span style="font-family:Arial,sans-serif"><span style="color:black">CONCLUSIONS: Our study shows that STEMI patients with diabetes are at a greater risk of developing HF, both at the acute stage and long after the MI. Interestingly, the incidence of acute HF is higher that recurrent MI in post-STEMI diabetic patients. Furthermore, in non-diabetic and diabetic patients, HF within the first year after STEMI is strongly associated with increased mortality. New strategies are urgently needed to avoid the development of HF after STEMI, especially in diabetic patients.</span></span></span></span></span></span></p>