Cumulative prognostic effect of diabetes and myocardial injury in patients attended in the emergency room

Abstract

\n \n \n Diabetes and myocardial injury are clinical conditions associated with cardiovascular events and increased mortality during follow-up. It is not known to what extent both conditions enhance their prognostic effect in patients seen in the emergency room with cardiac troponin determination.\n \n \n \n This study aims to evaluate the prognostic implication of diabetes and myocardial injury in patients attended in the emergency room with cardiac troponin determination.\n \n \n \n Retrospective observational cohorts study, in which all the patients attended the emergency room from January 2012 and December 2013 with a troponin determination. The sample was categorized according to the diabetes mellitus condition and myocardial injury (troponin below 99 th), studying four groups: non-diabetic without myocardial injury (G1), diabetic without myocardial injury (G2), non-diabetic with myocardial injury (G3), and diabetic with myocardial injury (G4). Baseline clinic characteristics and prognostic data were studied with a four years follow-up.\n \n \n \n A total of 3622 patients were studied; 924 (25 55%) diabetics. Three hundred seventy-one diabetic patients (40% of all diabetic patients) had an elevated troponin determination, while six hundred seventy-eights non-diabetic patients had elevated troponin (25 13% from all non-diabetics). Diabetic patients were significantly older (mean age 74 vs. 67 years). They had more frequently history of hypertension (81 9% vs 53 2%), acute myocardial infarction (31 6% vs 15 8%), heart failure (11 1% vs 5 7%), peripheral vascular disease (11 1% vs 5 2%), cerebrovascular disease (11 4% vs 6 6%), chronic pulmonary disease (23 3% vs 16 2%) and renal impairment (16 8% vs 5 2%). At four years of follow-up, G2, G3 and G4 had higher mortality than G1 (HR (95IC): 1,352 (1,080–1,693), 2,896 (2,896–3,477), and 3,441 (2,809–4,216), respectively). A multivariate competing risk model was used to obtain the HRs for readmission for myocardial infarction and heart failure between G2, G3 and G4 in relation to G1 (HR (IC 95%) 2,511 (1,592–3,96), 2,682 (1,739–4,138) and 5,036 (3,221–7,876), respectively for myocardial infarction, and 2,663 (1,825–3,886), 2,562 (1,753–3,744) and 4,292 (2,936–6,274) respectively for heart failure).\n \n \n \n Both conditions, myocardial injury, and diabetes have a prognostic impact at a long-term follow-up with a cumulative effect, being the troponin elevation, a better prognostic marker of death risk, and similar to diabetes history for the risk of myocardial infarction and heart failure.\n \n \n \n Type of funding sources: None. ICC hospitalization cumulativeincidence IAM cumulative incidence\n