Impact of type 2 diabetes mellitus on in-hospital outcomes in patients with ST-elevation myocardial infarction : a nationwide study in Germany

Abstract

Background Type 2 diabetes mellitus (T2DM) represents a substantial health burden especially regarding cardiovascular diseases. In this context, the presence of T2DM adversely affects both disease emergence and progression. Therefore, this study investigated the impact of T2DM on outcomes in patients hospitalized for ST-elevation myocardial infarction (STEMI).

Methods We used the nationwide German inpatient statistics of the years 2005-2022 for statistical analysis. Hospitalizations of patients who were admitted due to STEMI in German hospitals were included in this study. The impact of T2DM on in-hospital adverse events was evaluated, whereas patients with type 1 diabetes mellitus (T1DM) were excluded.

Results Overall, data on 1,590,775 hospitalizations of patients admitted due to STEMI were included; among these 379,346 (23.8%) patient-cases had T2DM. STEMI patients with T2DM were older (71.0 [62.0-79.0] vs. 66.0 [55.0-77.0] years, P < 0.001) and had an aggravated comorbidity burden. STEMI patients with T2DM were less often treated with percutaneous coronary intervention (61.2% vs. 66.7%, P < 0.001), whereas coronary-artery bypass graft was more often performed (5.0% vs. 3.9%, P < 0.001). The in-hospital case-fatality was significantly higher in T2DM patients (16.0% vs. 13.3%, P < 0.001). In multivariable analysis, T2DM was independently associated with lower usage of percutaneous intervention (OR 0.89 [95%CI 0.89-0.90], P < 0.001) and increased case-fatality (OR 1.03 [95%CI 1.01-1.04], P < 0.001).

Conclusion In STEMI patients, T2DM was associated with an increased case-fatality and higher complication rate in the light of an underuse of interventional revascularization.