Impact of acute diabetes decompensation on outcomes of diabetic patients admitted with ST-elevation myocardial infarction.

ABSTRACT:

Background

Acute hyperglycemia is associated with worse outcomes in diabetic patients admitted with ST-elevation myocardial infarction (STEMI). However, the impact of full-scale decompensated diabetes on STEMI outcomes has not been investigated.

Methods

We utilized the national inpatient sample (2003-2014) to identify adult diabetic patients admitted with STEMI. We defined decompensated diabetes as the presence of diabetic ketoacidosis (DKA) or hyperglycemic hyperosmolar state (HHS). We compared in-hospital morbidity and mortality and cost between patients with and without diabetes decompensation before and after propensity-score matching.

Results

A total of 73,722 diabetic patients admitted with STEMI were included in the study. Of those, 1131 (1.5%) suffered DKA or HSS during the hospitalization. After propensity-score matching, DKA/HHS remained associated with a significant 32% increase in in-hospital mortality (25.6% vs. 19.4%, p?=?0.001). The DKA/HHS group also had higher incidences of acute kidney injury (39.4% vs. 18.9%, p?adjusted OR 0.66, 95%CI 0.44-0.98, p?=?0.039).

Conclusions

Decompensated diabetes complicates?~?1.5% of STEMI admissions in diabetic patients. It is associated with lower rates of referral for angiography and revascularization, and a negative differential impact on in-hospital morbidity and mortality and cost.

SUBMITTER: Issa M 

PROVIDER: S-EPMC6050700 | biostudies-literature | 2018

REPOSITORIES: biostudies-literature