- Journal
- ARCHIVES OF CARDIOVASCULAR DISEASES
- Année
- 2022
- Volume
- 115
- Numéro
- 5
- Pages
- 264-275
- Mois
- MAY
- DOI
- 10.1016/j.acvd.2022.02.004
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. 64.7 years; 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).(c) 2022 Elsevier Masson SAS. All rights reserved.