Available online 20 April 2022, 101349

What is already known about this subject?

Diabetes mellitus (DM) is highly prevalent among individuals hospitalized with acute myocardial infarction (AMI) and is associated with increased risk for long-term mortality.

What is the key question?

Does the impact of diabetes on adverse clinical outcomes after AMI depend on the age of the patient?

What are the new findings?

Over a median follow-up of three years, diabetes was associated with a 32% higher all-cause mortality after adjusting for multiple covariates in the entire cohort.

In particular, it was confirmed that young patients with DM had a > 2-fold higher risk for all-cause mortality compared to those without DM after AMI.

How might this impact on clinical practice in the foreseeable future?

These findings highlight the need for more aggressive therapies aimed at preventing future adverse cardiovascular events in young patients post-AMI.

: To test the hypothesis that the impact of diabetes mellitus on clinical outcomes after acute myocardial infarction (AMI) can vary by age.

: A total of 12,600 AMI patients from the Korea Acute Myocardial Infarction Registry-National Institute of Health (KAMIR-NIH) between November 2011 and December 2015 was classified into young (n = 3,590 [29%]) and old (n = 9,010 [72%]). Those less than 55 years of age were considered young. We performed comparisons of baseline characteristics, in-hospital treatments, and 3-year clinical outcomes between patients with and without diabetes after stratification according to age group.

: The prevalence of diabetes mellitus was 27% in the young AMI group. In the multivariable adjusted model of the entire cohort, diabetes mellitus was associated strongly with 3-year all-cause mortality (13% vs. 6.8%; adjusted hazard ratio [HR], 1.318; 95% confidence interval [CI], 1.138-1.526; P<0.001). When the entire cohort was subdivided into two age groups, young diabetic patients showed a 107% higher mortality rate than those without diabetes (adjusted HR, 2.07 [1.15-3.72]; P = 0.015). Meanwhile, old diabetic patients had a 25% higher risk of mortality than non-diabetic patients (adjusted HR, 1.25 [1.08-1.46]; P = 0.004). The interaction of diabetes with age was significant (adjusted P for interaction = 0.008).

: Diabetes mellitus is not uncommon in younger AMI patients, and the relative risk of 3-year mortality is significantly higher in young patients than in older counterparts. More aggressive treatments are needed to prevent future cardiovascular events in younger patients after AMI.

acute myocardial infarction

diabetes mellitus

age

prognosis

© 2022 Elsevier Masson SAS. All rights reserved.