Background The long-term excess risk of death associated with diabetes following acute myocardial infarction is unknown. We determined the excess risk of death associated with diabetes among patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after adjustment for comorbidity, risk factors and cardiovascular treatments.
Methods Nationwide population-based cohort (STEMI n=281 259 and NSTEMI n=422 661) using data from the UK acute myocardial infarction registry, MINAP, between 1 January 2003 and 30 June 2013. Age, sex, calendar year and country-specific mortality rates for the populace of England and Wales (n=56.9 million) were matched to cases of STEMI and NSTEMI. Flexible parametric survival models were used to calculate excess mortality rate ratios (EMRR) after multivariable adjustment. This study is registered at ClinicalTrials.gov (NCT02591576).
Results Over 1.94 million person-years follow-up including 120 568 (17.1%) patients with diabetes, there were 187 875 (26.7%) deaths. Overall, unadjusted (all cause) mortality was higher among patients with than without diabetes (35.8% vs 25.3%). After adjustment for age, sex and year of acute myocardial infarction, diabetes was associated with a 72% and 67% excess risk of death following STEMI (EMRR 1.72, 95% CI 1.66 to 1.79) and NSTEMI (1.67, 1.63 to 1.71). Diabetes remained significantly associated with substantial excess mortality despite cumulative adjustment for comorbidity (EMRR 1.52, 95% CI 1.46 to 1.58 vs 1.45, 1.42 to 1.49), risk factors (1.50, 1.44 to 1.57 vs 1.33, 1.30 to 1.36) and cardiovascular treatments (1.56, 1.49 to 1.63 vs 1.39, 1.36 to 1.43).
Conclusions At index acute myocardial infarction, diabetes was common and associated with significant long-term excess mortality, over and above the effects of comorbidities, risk factors and cardiovascular treatments.
- CORONARY HEART DISEASE
- Epidemiology of cardiovascular disease
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Contributors OAA and CPG designed the study. OAA drafted the manuscript, analysed the data and interpreted the results. TBD and MH provided scientific input. CPG provided expert clinical opinion. All the authors read, commented and approved the final version of the manuscript.
Funding CPG is funded by the National Institute for Health Research (NIHR–CTF–2014–03–03) as Associate Professor and Honorary Consultant Cardiologist. OA is funded by ACS Risk Working Group (number 556011–7482). TBD and MH are funded by the British Heart Foundation as a research assistant and research fellow, respectively, (PG/13/81/30474). The Myocardial Ischaemia National Audit Project (MINAP) is commissioned by the Health Quality Improvement Partnership (HQIP) as part of the National Clinical Audit and Patient Outcomes Programme (NCAPOP).
Competing interests None declared.
Ethics approval Ethical approval was not required under National Health Service (NHS) research governance arrangements. The National Institute for Cardiovascular Outcomes Research (NICOR) which includes the Myocardial Ischaemia National Audit Project (MINAP) database (Ref: NIGB: ECC 1-06 (d)/2011) has support under section 251 of the NHS Act 2006 to use patient information for medical research without consent.
Provenance and peer review Not commissioned; externally peer reviewed.