Impact of type 1 diabetes mellitus on mortality rate and outcome of hospitalized patients with myocardial infarction

Abstract

Introduction Type 1 diabetes mellitus (T1D) is associated with an increased cardiovascular risk. We aimed to investigate the influence of T1D on myocardial infarction (MI) patients’ mortality. Materials and methods The German nationwide inpatient sample 2005–2016 was used for statistical analysis. Hospitalized MI patients were stratified for T1D and impact of T1D on in-hospital outcomes was investigated. Results In total, 3,307,703 hospitalizations of MI patients (37.6 % females, 56.8 % aged ≥70 years) were counted in Germany 2005–2016 and included in this analysis. In 18,625 (0.6 %) of the cases additionally T1D was coded. Overall, 410,737 (12.4 %) in-hospital deaths occurred within the investigation period. MI patients with T1D were younger (64.0 [IQR 52.0–75.0] vs. 73.0 [62.0–81.0] years, P < 0.001), more often female (38.7 % vs. 37.6 %, P < 0.001) and obese (13.2 % vs. 9.3 %, P < 0.001). Comorbidities like peripheral arterial (14.2 % vs. 6.4 %, P < 0.001) and kidney disease (38.5 % vs. 27.2 %, P < 0.001) were more prevalent in MI patients with T1D. T1D was an independent risk factor for in-hospital death (OR 1.23 [95%CI 1.18–1.29], P < 0.001), recurrent MI (OR 1.56 [95%CI 1.35–1.80], P < 0.001), and stroke (OR 1.75 [95%CI 1.63–1.88], P < 0.001). While percutaneous coronary intervention (PCI, 37.8 % vs. 42.0 %, P < 0.001) was less often, coronary artery bypass grafting (CABG, 7.4 % vs. 4.6 %, P < 0.001) was more often performed in MI patients with T1D, confirmed by regression analysis (PCI: OR 0.66 [95%CI 0.64–0.68], P < 0.001; CABG: OR 1.54 [95%CI 1.45–1.63], P < 0.001). Conclusions T1D represents an important and independent risk factor for mortality in MI patients. The results emphasize the high vulnerability of T1D patients who suffer from MI.