Acute myocardial infarction in the young with diabetes mellitus- national inpatient sample study with sex-based difference in outcomes.
Acute myocardial infarction
Diabetes
National Inpatient Sample
Young
Journal
International journal of cardiology
ISSN: 1874-1754
Titre abrégé: Int J Cardiol
Pays: Netherlands
ID NLM: 8200291
Informations de publication
Date de publication:
01 03 2021
01 03 2021
Historique:
received:
25
04
2020
revised:
05
07
2020
accepted:
04
08
2020
pubmed:
12
8
2020
medline:
28
5
2021
entrez:
12
8
2020
Statut:
ppublish
Résumé
Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes. NIS 2010-2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N = 30,950) and women (N = 17,928) patients diagnosed with diabetes were identified and stratified as young if age >18 and <45 years. Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78-0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54-0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74-1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation. There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.
Sections du résumé
BACKGROUND
Mortality after AMI is on the decreasing trend; however, this favorable trend is not observed in the young, especially women. Therefore, we conducted a retrospective analysis using the Nationwide Inpatient Sample (NIS) to identify sex-based outcomes following AMI in young with diabetes.
METHODS
NIS 2010-2014 was used to identify all patients with AMI using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Men (N = 30,950) and women (N = 17,928) patients diagnosed with diabetes were identified and stratified as young if age >18 and <45 years.
RESULTS
Young women with AMI and concomitant diabetes having a higher burden of overall traditional and non-traditional comorbidities. NSTEMI was the major presentation in women as compared to men. Young women with AMI and concomitant diabetes were less likely to receive revascularization with PCI [51.1% vs. 58.2%; OR 0.86, CI 0.78-0.94] or CABG [7.9% vs. 10.1%; OR 0.64, CI 0.54-0.75]. Adjusted all-cause in-hospital mortality did not differ significantly between the two groups [OR 1.06, CI 0.74-1.52]. Women had lower odds of developing cardiogenic shock, ventricular arrhythmias, and AKI, and were more likely to develop major bleeding requiring transfusion, and mitral regurgitation.
CONCLUSION
There were significant differences between young men and women with diabetes in terms of baseline characteristics and clinical presentation, use of revascularization, and cardiac complications, yet overall, in-hospital mortality does not appear to differ. More studies are needed to identify the interaction of sex and diabetes in young AMI population, and areas for practice improvement.
Identifiants
pubmed: 32781013
pii: S0167-5273(20)33529-4
doi: 10.1016/j.ijcard.2020.08.002
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
35-41Informations de copyright
Copyright © 2020. Published by Elsevier B.V.
Déclaration de conflit d'intérêts
Declaration of competing interest GCF: Consulting for Abbott, Amgen, AstraZeneca, Bayer, Edwards, Janssen, Medtronic, Merck, and Novartis. The authors report no relationships that could be construed as a conflict of interest