Diabetes status and grade of left ventricular ejection fraction as predictors of outcomes in patients with Non-ST-segment elevation myocardial infarction

초록

Background: Compared to previous studies, we analyzed the 3-year outcomes in patients with and without diabetes mellitus (DM) and non-ST-segment elevation myocardial infarction (NSTEMI) according to left ventricular ejection fraction (LVEF) to provide more useful information. Methods: In total, 4594 patients from the Korea acute MI registry-NIH dataset were were classified into DM (n = 1608) and non-DM (n = 2986) groups. The patients were further classified into heart failure with reduced EF (HFrEF), HF with mildly reduced EF (HFmrEF), and HF with preserved EF (HFpEF) subgroups. The primary outcome measure was all-cause mortality. Secondary outcomes included cardiac death (CD), non-CD (NCD), recurrent MI, repeat revascularization, and hospitalization for HF (HHF). Results: After adjustment, in-hospital mortality was highest in HFrEF but similar between HFmrEF and HFpEF in both DM and non-DM groups. During a 3-year follow-up period, after adjustment, in the DM group, all-cause mortality (p < 0.001 for all), CD, NCD, recurrent MI, and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In the non-DM group, all-cause mortality (p = 0.001 and p < 0.001, respectively) and CD and HHF rates were higher in the HFrEF subgroup than in the HFmrEF and HFpEF subgroups. In both the DM and non-DM groups, all-cause mortality and NCD rates were higher in the HFmrEF group than in the HFpEF group. Conclusion: In this multicenter prospective registry study, patients with NSTEMI with or without DM, the 3-year outcomes were the best in HFpEF, worst in HFrEF, and intermediate in HFmrEF patients.