Among patients with diabetes mellitus (DM) hospitalized for acute myocardial infarction (AMI), those with concomitant extracardiac vascular disease are more likely to develop clinical outcomes, according to a study in the American Journal of Cardiology.

Researchers evaluated the management and outcomes of patients with AMI and diabetes, stratified by the number of extracardiac vascular comorbidities and site of vascular comorbidity. They obtained discharge data from the National Inpatient Sample (NIS) database, Healthcare Cost and Utilization Project, and Agency for Healthcare Research and Quality.

Eligible participants were aged 18 years or older with type 1 and type 2 DM who were hospitalized for type 1 AMI between October 2015 to December 2018. Participants were stratified into 4 groups based on number of extracardiac vascular comorbidities: reference group (those without extracardiac vascular disease), and groups with participants having 1, 2, or 3 or more extracardiac vascular comorbidities. Patients with extracardiac vascular comorbidity were stratified into 5 groups based on site: cerebrovascular disease (CVD), renovascular disease, neuropathy, retinopathy, and peripheral artery disease (PAD). In-hospital all-cause mortality was the primary clinical outcome.


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Among 1,116,670 patients with DM who were hospitalized for AMI, 67.2% had no diagnosed extracardiac vascular disease, and 32.8% had 1 or more extracardiac vascular comorbidity. Of the group with extracardiac vascular comorbidity, 24.8% had 1 vascular comorbidity, 6.8% had 2 vascular comorbidities, and 1.2% had 3 or more vascular comorbidities. Patients with extracardiac vascular disease were older vs those without extracardiac vascular disease and had a higher prevalence of comorbidities.

Participants who had extracardiac vascular disease had lower odds of receiving coronary angiography (adjusted odds ratio [aOR], 0.90; 95% CI, 0.90-0.91) and higher odds of having coronary artery bypass grafting (aOR, 1.16; 95% CI, 1.14-1.18), percutaneous coronary intervention (aOR, 0.82; 95% CI, 0.82-0.83), and increased aOR of all in-hospital outcomes, including mortality (aOR, 1.05; 95% CI, 1.04-1.07), major adverse cardiovascular and cerebrovascular events (MACCE) (aOR, 1.19; 95% CI, 1.18-1.21), major bleeding (aOR, 1.11; 95% CI, 1.09-1.13), and stroke (aOR, 1.72; 95% CI, 1.68-1.76) compared with patients who did not have extracardiac vascular disease.

Multivariable adjustment analysis showed that patients with CVD and PAD had increased odds of mortality, MACCE, stroke, and major bleeding (P <.001). Patients with PAD had the highest aOR of mortality (aOR, 1.29; 95% CI, 1.27-1.32), and the highest aORs of MACCE (aOR, 1.82; 95% CI, 1.78-1.87), acute ischemic stroke (aOR, 4.25; 95% CI, 4.10-4.40), and major bleeding (aOR, 1.51; 95% CI, 1.45-1.57) were observed in patients with CVD.

Study limitations include the possibility of undercoding or misclassification, and the NIS does not have data on the severity of vascular disease, functional disabilities, or pharmacologic therapy. In addition, the NIS does not include the specific cause of death, which prevented analysis of cardiovascular mortality, and the analysis was limited to in-hospital outcomes.

“Our findings emphasize the importance of early diagnosis and management of extracardiac vascular disease in patients with DM, particularly in certain vascular beds, to improve their prognosis and management,” noted the researchers.

Reference

Istanbuly S, Matetic A, Roberts DJ, et al. Relation of extracardiac vascular disease and outcomes in patients with diabetes (1.1 million) hospitalized for acute myocardial infarction. Am J Cardiol. Published online May 9, 2022. doi: 10.1016/j.amjcard.2022.04.005