Impact of diabetes on the in-hospital outcome of patients with STEMI: Results from the MIRAMI registry

Introduction Diabetes is a major cardiovascular risk factor of coronary artery disease including STEMI. Objective The objectives of our study were to describe the demographic characteristics of diabetic patients admitted with STEMI, to determine the management modalities used in these patients, and their in-hospital outcome. Method This is a retrospective study including diabetic patients admitted for STEMI. The registry included 2021 patients admitted for STEMI between January 2002 and December 2019. Results Our study included 791 diabetic patients (39.1%). Mean age was 60.68±11.13years. Hypertension (45.8% vs. 22.6%; P<0.001), dyslipidemia (21.6% vs. 7.3%; P<0.001) and chronic kidney disease (32.3% vs. 21.3%; P<0.001) were more frequent in diabetic patients whereas, smoking (56% vs. 73%; P<0.001) were more frequent in non-diabetic patients. In diabetic patients, non-typical initial presentation was more frequent (P=0.05) and the time to hospital admission was significantly longer (P<0.001). The anterior territory of STEMI was more frequent in diabetic patients (P=0.003). The mean LVEF was comparable between the two groups (P=0.3). Urgent reperfusion therapy (59.8% vs. 51.9%; P<0.001), with Primary PCI (PPCI) (24.4% vs. 23.8%; P=0.403) or thrombolysis (28.1% vs. 35.4%; P<0.001), was less frequently provided among the diabetic population (P<0.001). However, there was a significant trend to a progressive increase over the years of the study period in the rate of PPCI and out-of-hospital thrombolysis received by diabetic patients (P=0.02 and 0.001, respectively). The success rate of reperfusion with thrombolysis was lower in diabetic patients (49.5% vs. 35.8%; P<0.001) but it was comparable between the 2 groups in with PPCI (90.1% vs. 90.4%; P=0.906). In-hospital mortality was significantly higher in diabetic patients compared to the rest of the population (11.9% vs. 6.7%; P<0.001). Independent predictors of morality were: heart rate greater than 100 bpm at admission (P=0.011), PPCI failure (P<0.001), ventricular tachycardia (P=0.032), and cardiogenic shock (P=0.002). Conclusion Our study showed that diabetic patients admitted for STEMI are less frequently reperfused and have a worse in-hospital outcome compared with non-diabetic patients.