Gatuz Marlon V, Abu-Fanne Rami, Abramov Dmitry, Mamas Mamas A, Roguin Ariel, Kobo Ofer
Department of Cardiology, Hillel Yaffe Medical Center, Hadera 3200003, Israel.
Department of Cardiology, Linda Loma University Health, Loma Linda, CA 92354, USA.
Biomedicines. 2024 Aug 20;12(8):1900. doi: 10.3390/biomedicines12081900.
Diabetes mellitus (DM) significantly impacts cardiovascular outcomes, particularly in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). The presence of polyvascular disease further complicates the prognosis due to the increased burden of atherosclerosis and comorbidities. This study was designed to investigate the combined impact of DM and polyvascular disease on outcomes in patients with AMI and CS.
Using the National Inpatient Sample database, we analyzed 39,140 patients with AMI complicated by CS and known polyvascular disease. The patients were stratified by diabetes status. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, cerebrovascular accident (CVA) and major bleeding. Multivariable logistic regression models were used to examine the association between in-hospital outcomes and diabetes, adjusting for baseline differences.
Of the study population, 54% had DM. The patients with DM were younger (69.5 vs. 72.1 years, < 0.001) and more likely to be female (36.7% vs. 34.2%, < 0.001). After adjustment, the patients with DM showed a 17% increased mortality risk (aOR 1.17, 95% CI: 1.11-1.23, < 0.001) and a higher risk of major adverse cardiovascular and cerebrovascular events (aOR 1.05, 95% CI: 1.01-1.10, = 0.020).
DM significantly impacts outcomes in patients with AMI complicated by CS and polyvascular disease, leading to increased mortality risk, longer hospital stays, and higher healthcare costs. These findings underscore the need for targeted interventions and specialized care strategies for this high-risk population.
糖尿病（DM）对心血管结局有显著影响，尤其是在合并心源性休克（CS）的急性心肌梗死（AMI）患者中。由于动脉粥样硬化负担和合并症增加，多血管疾病的存在使预后更加复杂。本研究旨在调查DM和多血管疾病对AMI合并CS患者结局的综合影响。
利用国家住院样本数据库，我们分析了39140例合并CS且患有已知多血管疾病的AMI患者。患者按糖尿病状态分层。该研究评估了院内主要不良心血管和脑血管事件（MACCE）、死亡率、脑血管意外（CVA）和大出血情况。采用多变量逻辑回归模型来检验院内结局与糖尿病之间的关联，并对基线差异进行校正。
在研究人群中，54%患有DM。患有DM的患者更年轻（69.5岁对72.1岁，<0.001），且女性比例更高（36.7%对34.2%，<0.001）。校正后，患有DM的患者死亡风险增加17%（调整后比值比[aOR]为1.17，95%置信区间[CI]：1.11 - 1.23，<0.001），主要不良心血管和脑血管事件风险更高（aOR为1.05，95%CI：1.01 - 1.10，=0.020）。
DM对合并CS和多血管疾病的AMI患者的结局有显著影响，导致死亡风险增加、住院时间延长和医疗费用更高。这些发现强调了针对这一高危人群进行有针对性干预和制定专门护理策略的必要性。
