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OUTCOMES AND PROGNOSIS OF PATIENTS WITH KNOWN, NEWLY DIAGNOSED AND WITHOUT DIABETES MELLITUS PRESENTING WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: FROM THE HORIZONS-AMI STUDY
577 JACC April 5, 2016 Volume 67, Issue 13
Acute Coronary Syndromes OUTCOMES AND PROGNOSIS OF PATIENTS WITH KNOWN, NEWLY DIAGNOSED AND WITHOUT DIABETES MELLITUS PRESENTING WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: FROM THE HORIZONS-AMI STUDY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: Clinical and Therapuetic Factors Affecting Outcome After Acute Coronary Syndromes Abstract Category: 14. Acute Coronary Syndromes: Clinical Presentation Number: 1169-029 Authors: Konstanze Ertelt, Sorin Brener, Roxana Mehran, Girma Minalu Ayele, Gregg Stone, Cardiovascular Research Foundation, New York City, NY, USA Background: Background - Diabetes mellitus (DM) is an independent predictor for adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI). Outcomes and prognosis in STEMI patients with newly diagnosed DM (NDM) are less well described.
Methods: In HORIZONS-AMI 3,602 patients with STEMI were randomized to bivalirudin vs. heparin and a glycoprotein IIb/IIIa inhibitor and to a paclitaxel-eluting stent (PES) or a bare-metal stent (BMS). Diabetes mellitus was defined as a history of hyperglycemia managed by insulin, oral hypoglycemic agents, or diet. NDM was defined as the absence of treatment for DM at baseline and its addition at discharge. We evaluated the outcomes of patients with DM NDM, and those without DM at 30 days, and at 3 years. Results: DM was present in 593/3,599 patients (16.5 %) and NDM was noted in 130 cases (3.6%). Compared with nondiabetics, those with DM and NDM experienced significantly higher rates of 3-year death (11.4 % and 12.0 % vs. 5.6%, respectively, P<0.0001) and major adverse cardiac events (MACE - 29.6 % and 30.2% % vs. 19.9%, respectively, P<0.0001). There was no significant difference between new and known diabetic patients. DM and NDM were independent predictors of 3-year mortality: DM - HR=2.01 [1.43, 2.82], p<0.0001 and NDM - HR=2.55 [1.37, 4.74], p=0.003). Conclusions: Patients with DM and NDM experienced higher and similar rates of death and MACE compared to nondiabetics. DM and NDM were independent predictors of 3-year mortality. Identifying NDM prior to hospital discharge may enhance secondary prevention interventions in patients with STEMI.
Acute Coronary Syndromes OUTCOMES AND PROGNOSIS OF PATIENTS WITH KNOWN, NEWLY DIAGNOSED AND WITHOUT DIABETES MELLITUS PRESENTING WITH ACUTE ST-SEGMENT ELEVATION MYOCARDIAL INFARCTION: FROM THE HORIZONS-AMI STUDY Poster Contributions Poster Area, South Hall A1 Sunday, April 03, 2016, 9:45 a.m.-10:30 a.m. Session Title: Clinical and Therapuetic Factors Affecting Outcome After Acute Coronary Syndromes Abstract Category: 14. Acute Coronary Syndromes: Clinical Presentation Number: 1169-029 Authors: Konstanze Ertelt, Sorin Brener, Roxana Mehran, Girma Minalu Ayele, Gregg Stone, Cardiovascular Research Foundation, New York City, NY, USA Background: Background - Diabetes mellitus (DM) is an independent predictor for adverse events in patients with acute ST-segment elevation myocardial infarction (STEMI). Outcomes and prognosis in STEMI patients with newly diagnosed DM (NDM) are less well described.
Methods: In HORIZONS-AMI 3,602 patients with STEMI were randomized to bivalirudin vs. heparin and a glycoprotein IIb/IIIa inhibitor and to a paclitaxel-eluting stent (PES) or a bare-metal stent (BMS). Diabetes mellitus was defined as a history of hyperglycemia managed by insulin, oral hypoglycemic agents, or diet. NDM was defined as the absence of treatment for DM at baseline and its addition at discharge. We evaluated the outcomes of patients with DM NDM, and those without DM at 30 days, and at 3 years. Results: DM was present in 593/3,599 patients (16.5 %) and NDM was noted in 130 cases (3.6%). Compared with nondiabetics, those with DM and NDM experienced significantly higher rates of 3-year death (11.4 % and 12.0 % vs. 5.6%, respectively, P<0.0001) and major adverse cardiac events (MACE - 29.6 % and 30.2% % vs. 19.9%, respectively, P<0.0001). There was no significant difference between new and known diabetic patients. DM and NDM were independent predictors of 3-year mortality: DM - HR=2.01 [1.43, 2.82], p<0.0001 and NDM - HR=2.55 [1.37, 4.74], p=0.003). Conclusions: Patients with DM and NDM experienced higher and similar rates of death and MACE compared to nondiabetics. DM and NDM were independent predictors of 3-year mortality. Identifying NDM prior to hospital discharge may enhance secondary prevention interventions in patients with STEMI.