The influence of diabetes on in-hospital and long-term mortality in patients with myocardial infarction complicated by cardiogenic shock: results from the PL-ACS registry.

BACKGROUND: Cardiogenic shock (CS) affects the prognosis in patients with myocardial infarction (MI). An additional factor affecting the prognosis is diabetes mellitus (DM).

AIM: To evaluate the impact of DM on in-hospital and long-term mortality in patients with MI complicated by CS, who were included in the Polish Registry of Acute Coronary Syndromes (PL-ACS). We also sought to demonstrate a relationship between treatment method and mortality in this group.

METHODS: 71,290 consecutive patients with non-ST elevation MI (NSTEMI; 33,392) and ST elevation MI (STEMI; 37,898) were included in the PL-ACS register. CS was diagnosed on admission in 4,144 patients. This group included 1,159 patients with DM.

RESULTS: The patients with DM were older, more frequently female and more frequently presented with hypertension, hypercholesterolaemia, obesity, suffered from multivessel coronary disease significantly more frequently (76.4% vs. 64.6%; p = 0.00003) and had lower coronary angioplasty efficacy (TIMI 3 flow) (67% vs. 75.8%; p = 0.001) compared to patients without DM. The mortality rate comparisons for patients with DM vs. those without DM, respectively, were as follows: inhospital mortality, 61.4% vs. 55.9%; p = 0.001 (revascularisation treatment: 45.7% vs. 39.5%; p = 0.03, conservative treatment: 69.3% vs. 64.6%; p = 0.02) and 3-year mortality 78.6% vs. 70.7%; p 〈 0.0001 (revascularisation treatment: 64.7% vs. 55.0%; p = 0.001, conservative treatment: 85.5% vs. 79.2%; p = 0.0001). In the multivariate analysis, DM was, with borderline statistical significance, an independent predictor of higher in-hospital mortality (OR = 1.16; 95% CI 1.00-1.35; p = 0.054] and 3-year mortality (HR = 1.11; 95% CI 1.02-1.20; p = 0.01). Interestingly, after excluding patients who died in the hospital, DM was still associated with significantly higher 3-year mortality (50.1% vs. 40.0%; p 〈 0.0001). Multivariate analysis revealed that DM was still an independent risk factor for higher 3-year mortality (HR = 1.21; 95% CI 1.04-1.41; p = 0.02).

CONCLUSIONS: Diabetes is associated with higher in-hospital and long-term mortality in patients with MI complicated by CS. Revascularisation treatment, compared to conservative treatment, reduces mortality in this group of patients.