Comparison of 2-year clinical outcomes between diabetic versus nondiabetic patients with acute myocardial infarction after 1-month stabilization: Analysis of the prospective registry of DIAMOND (DIabetic acute myocardial infarctiON Disease) in Korea: an observational registry study.

Abstract

This study assessed the 2-year clinical outcomes of patients with diabetes mellitus (DM) after acute myocardial infarction (AMI) in a cohort of the DIAMOND (DIabetic Acute Myocardial infarctiON Disease) registry. Clinical outcomes were compared between 1088 diabetic AMI patients in the DIAMOND registry after stabilization of MI and 1088 nondiabetic AMI patients from the KORMI (Korean AMI) registry after 1:1 propensity score matching using traditional cardiovascular risk factors. Stabilized patients were defined as patients who did not have any clinical events within 1 month after AMI. Primary outcomes were the 2-year rate of major adverse cardiac events (MACEs), a composite of all-cause death, recurrent MI (re-MI), and target vessel revascularization (TVR). Matched comparisons revealed that diabetic patients exhibited significantly lower left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate and smaller stent size. Diabetic patients exhibited significantly higher 2-year rates of MACE (8.0% vs 3.7%), all-cause death (3.9% vs 1.4%), re-MI (2.8% vs 1.2%), and TVR (3.5% vs 1.3%) than nondiabetic patients (all P<0.01), and higher cumulative rates in Kaplan–Meier analyses of MACE, all-cause death, and TVR (all P<0.05). A multivariate Cox regression analysis revealed that chronic kidney disease, LVEF<35%, and long stent were independent predictors of MACE, and large stent diameter and the use of drug-eluting stents were protective factors against MACE. The 2-year MACE rate beyond 1 month after AMI wassignificantly higher in DM patients than non-DM patients, and this rate was associated with higher comorbidities, coronary lesions, and procedural characteristics in DM. Abbreviations: ACE-I = angiotensin-converting enzyme inhibitor, AMI = acute myocardial infarction, ARBs = angiotensin receptor blockers, BMI = body mass index, BP = blood pressure, CAD = coronary artery disease, CKD = chronic kidney disease, CK-MB = creatine kinase-myocardial band fraction, CV = cardiovascular, DM = diabetes mellitus, DPP4-I = dipeptidyl peptidase 4 inhibitors, eGFR = estimated glomerular filtration rate, GP = glycoprotein, hs-CRP = high-sensitivity C-reactive protein, LAD = left anterior descending artery, LCX = left circumflex artery, LM = left main coronary artery, LVEF = left ventricular ejection fraction, MACE = major adverse cardiac events, PCI = percutaneous coronary intervention, QCA = quantitative coronary angiography, RCA = right coronary artery, reMI = recurrent myocardial infarction, ST = stent thrombosis, STEMI = ST-elevation myocardial infarction, TIMI = thrombolysis in myocardial infarction, TVR = target vessel revascularization.