Deleterious synergistic effects of acute heart failure and diabetes mellitus in patients with acute coronary syndrome: Data from the FAST-MI Registries

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. 64.7years; 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).

Keywords: Acute heart failure; Acute myocardial infarction; Diabetes mellitus; Diabète; Infarctus aigu du myocarde; Insuffisance cardiaque aiguë; Long-term outcomes; Résultats à long terme.