Impact of Type 2 Diabetes Mellitus and Myocardial Perfusion on Long-Term Risk of Heart Failure and All-Cause Mortality following Interventional Treatment of ST-Elevation Myocardial Infarction

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 456-P
Author(s):  
ANDRZEJ TOMASIK ◽  
KATARZYNA NABRDALIK ◽  
HANNA KWIENDACZ ◽  
TOMASZ SAWCZYN ◽  
MICHAL KUKLA ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Interventional Treatment ◽  
All Cause Mortality ◽  
St Elevation

scholarly journals Bias Implications of Outcome Misclassification in Observational Studies Evaluating Association Between Treatments and All‐Cause or Cardiovascular Mortality Using Administrative Claims

2020 ◽  
Vol 9 (17) ◽  
Author(s):  
Rishi J. Desai ◽  
Raisa Levin ◽  
Kueiyu Joshua Lin ◽  
Elisabetta Patorno
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Cardiovascular Mortality ◽  
Administrative Claims ◽  
National Death Index ◽  
All Cause Mortality ◽  
Predicted Values

Background The bias implications of outcome misclassification arising from imperfect capture of mortality in claims‐based studies are not well understood. Methods and Results We identified 2 cohorts of patients: (1) type 2 diabetes mellitus (n=8.6 million), and (2) heart failure (n=3.1 million), from Medicare claims (2012–2016). Within the 2 cohorts, mortality was identified from claims using the following approaches: (1) all‐place all‐cause mortality, (2) in‐hospital all‐cause mortality, (3) all‐place cardiovascular mortality (based on diagnosis codes for a major cardiovascular event within 30 days of death date), or (4) in‐hospital cardiovascular mortality, and compared against National Death Index identified mortality. Empirically identified sensitivity and specificity based on observed values in the 2 cohorts were used to conduct Monte Carlo simulations for treatment effect estimation under differential and nondifferential misclassification scenarios. From National Death Index, 1 544 805 deaths (549 996 [35.6%] cardiovascular deaths) in the type 2 diabetes mellitus cohort and 1 175 202 deaths (523 430 [44.5%] cardiovascular deaths) in the heart failure cohort were included. Sensitivity was 99.997% and 99.207% for the all‐place all‐cause mortality approach, whereas it was 27.71% and 33.71% for the in‐hospital all‐cause mortality approach in the type 2 diabetes mellitus and heart failure cohorts, respectively, with perfect positive predicted values. For all‐place cardiovascular mortality, sensitivity was 52.01% in the type 2 diabetes mellitus cohort and 53.83% in the heart failure cohort with positive predicted values of 49.98% and 54.45%, respectively. Simulations suggested a possibility for substantial bias in treatment effects. Conclusions Approaches to identify mortality from claims had variable performance compared with the National Death Index. Investigators should anticipate the potential for bias from outcome misclassification when using administrative claims to capture mortality.

scholarly journals Diabetes mellitus type 2 and acute myocardial infarction: prognostic options for interaction in patients of different age groups

2018 ◽  
Vol 21 (2) ◽  
pp. 105-112 ◽  
Author(s):  
Alla A. Garganeeva ◽  
Elena A. Kuzheleva ◽  
Ksenia N. Borel ◽  
Dina S. Kondratyeva ◽  
Sergey A. Afanasiev
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Acute Myocardial Infarction ◽  
Type 2 Diabetes Mellitus ◽  
Heart Disease ◽  
Ischaemic Heart Disease ◽  
Working Age

Background. Problems surrounding comorbidities of type 2 diabetes mellitus and coronary heart disease are some of the most important in medical science and practice, given their mutually negative impact on patients prognoses and quality of life. Aims. To study the impact of type 2 diabetes on the long-term prognoses of patients of different age categories, status-post acute myocardial infarction. (Data obtained from the Register of Acute Myocardial Infarction.) Materials and methods. The main data source was the Register of Acute Myocardial Infarction, maintained in Tomsk for more than 30 years. The study included 862 patients with acute myocardial infarction. The patients were monitored for 5 years. The primary endpoint was death from any cause during the observation period. Results. We separated the study cohort into 2 groups depending on patients ages: Group 1 (n = 358) included patients older than working age, Group 2 (n = 504) consisted of younger, employable patients. The combination of ischaemic heart disease and type 2 diabetes mellitus were diagnosed in 208 patients. The combination of ischaemic heart disease and type 2 diabetes was the cause of adverse prognosis among elderly patients and led to increased mortality rate during the 5-year post-infarction period (p = 0.0003). However, among younger, working patients who suffered myocardial infarction, the presence of type 2 diabetes did not have an independent negative effect on long-term disease prognosis. While in employable patients, a long history of diabetes mellitus significantly aggravated the course of the post-infarction period (p = 0.004). Conclusions. These data suggest an ambiguous prognostic effect of type 2 diabetes mellitus among working age and elderly patients status post myocardial infarction, in agreement with experimental studies conducted on laboratory animals. Further comprehensive analyses of the clinical and experimental data are needed to optimise therapies for patients who suffer from type 2 diabetes and comorbid ischaemic heart disease.

scholarly journals IMPACT OF COMBORBIDE LOAD ON CLINICAL COURSE OF INFERIOR WALL MYOCARDIAL INFARCTION WITH RIGHT VENTRICULAR INVOLVEMENT

2019 ◽  
Vol 20 (4) ◽  
pp. 63-70
Author(s):  
K. Yu. Glavatskikh ◽  
I. Yu. Lukyanova ◽  
V. I. Shalnev ◽  
I. Yu. Pchelin
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Right Ventricular ◽  
Clinical Course ◽  
Inferior Wall ◽  
Acute Period

The article presents data on the frequency and structure of comorbid pathology in patients with inferior wall myocardial infarction with right ventricular involvement. Its relationship with the clinical course of myocardial infarction in the acute period was studied. It was shown that patients with inferior wall myocardial infarction with right ventricular involvement have a high comorbid load. It was revealed that a more severe course of the acute period of myocardial infarction in these patients was associated with chronic cerebrovascular ischemia, fatty liver, chronic heart failure I–IIa stages, type 2 diabetes mellitus and obesity.  

scholarly journals The Association Between Metformin Treatment and Outcomes in Type 2 Diabetes Mellitus Patients With Heart Failure With Preserved Ejection Fraction: A Retrospective Study

2021 ◽  
Vol 8 ◽  
Author(s):  
Jianfang Wang ◽  
Yi Lu ◽  
Xinjia Min ◽  
Tan Yuan ◽  
Jia Wei ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Heart Failure ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Preserved Ejection Fraction ◽  
Metformin Group ◽  
Patients With Heart Failure ◽  
All Cause Mortality

Background: Metformin is the first-line antidiabetic medication for type 2 diabetes mellitus (T2DM). However, the association between metformin and outcomes in T2DM patients with heart failure with preserved ejection fraction (HFpEF) is still unknown. We aimed to explore the association between metformin and adverse outcome in T2DM patients with HFpEF.Methods: A total of 372 T2DM patients with HFpEF hospitalized from January 1, 2013, to December 31, 2017, were included in this retrospective cohort study. There were 113 and 259 subjects in metformin and non-metformin group, respectively. Subjects were followed up for all-cause mortality, cardiovascular death, all-cause hospitalization, and heart failure hospitalization.Results: The median follow-up period was 47 months. Eleven patients (2.49% per patient-year) in the metformin group and 56 patients (5.52% per patient-year) in the non-metformin group deceased during follow-up (P = 0.031). However, a multivariable Cox regression failed to show that metformin was an independent factor of all-cause mortality [HR (95% CI) = 0.682 (0.346–1.345); P = 0.269]. A subgroup analysis revealed a significant association between metformin and all-cause mortality in patients with a higher hemoglobin A1c (HbA1c) level (HbA1c ≥7%) [HR (95% CI) = 0.339 (0.117–0.997); P = 0.045]. The 4-year estimated number needed to treat (NNT) with metformin compared with non-metformin for all-cause mortality was 12 in all populations and 8 in the HbA1c ≥7% subgroup.Conclusions: Metformin was not independently associated with clinical outcomes in patients with T2DM and HFpEF, but was associated with lower all-cause mortality in the subgroup of patients with poor glycemic control. Prospective, randomized controlled trials are needed to further verify these findings.

scholarly journals 5-Year Clinical Outcomes of Successful Recanalisation for Coronary Chronic Total Occlusions in Patients With or Without Type 2 Diabetes Mellitus

2021 ◽  
Vol 8 ◽  
Author(s):  
Peizhi Wang ◽  
Deshan Yuan ◽  
Sida Jia ◽  
Pei Zhu ◽  
Ce Zhang ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Propensity Score ◽  
Diabetic Patients ◽  
Chronic Total Occlusions ◽  
All Cause Mortality

Background: Despite substantial improvement in chronic total occlusions (CTO) revascularization technique, the long-term clinical outcomes in diabetic patients with revascularized CTO remain controversial. Our study aimed to investigate the 5-year cardiovascular survival for patients with or without type 2 diabetes mellitus (DM) who underwent successful percutaneous coronary intervention (PCI) for CTO.Methods: Data of the current analysis derived from a large single-center, prospective and observational cohort study, including 10,724 patients who underwent PCI in 2013 at Fuwai Hospital. Baseline, angiographic and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which consisted of death, recurrent myocardial infarction (MI), stroke and target vessel revascularization (TVR). The secondary endpoint was all-cause mortality. Cox regression analysis and propensity-score matching was performed to balance the baseline confounders.Results: A total of 719 consecutive patients with ≥1 successful CTO-PCI were stratified into diabetic (n = 316, 43.9%) and non-diabetic (n = 403, 56.1%) group. During a median follow-up of 5 years, the risk of MACCE (adjusted hazard ratio [HR] 1.47, 95% confidence interval [CI] 1.08–2.00, P = 0.013) was significantly higher in the diabetic group than in the non-diabetic group, whereas the adjusted risk of all-cause mortality (HR 2.37, 95% CI 0.94–5.98, P = 0.068) was similar. In the propensity score matched population, there were no significant differences in the risk of MACCE (HR 1.27, 95% CI 0.92–1.75, P = 0.155) and all-cause mortality (HR 2.56, 95% CI 0.91–7.24, P = 0.076) between groups. Subgroup analysis and stratification analysis revealed consistent effects on 5-year MACCE across various subgroups.Conclusions: In patients who received successful CTO-PCI, non-diabetic patients were related to better long-term survival benefit in terms of MACCE. The risk of 5-year MACCE appeared to be similar in less-controlled and controlled diabetic patients after successful recanalization of CTO. Further randomized studies are warranted to confirm these findings.

The Impact of Renal Dysfunction on Outcomes of In-Hospital and Remote Periods in Patients With ST-Elevation Myocardial Infarction Combined With Type 2 Diabetes Mellitus

Kardiologiia ◽  
2015 ◽  
Vol 11_2015 ◽  
pp. 24-30 ◽  
Author(s):  
V.N. Karetnikova Karetnikova ◽  
M.V. Evseeva Evseeva ◽  
M.V. Zykov Zykov ◽  
I.S. Bykova Bykova ◽  
V.V. Kalaeva Kalaeva ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Type 2 Diabetes ◽  
Type 2 Diabetes Mellitus ◽  
Renal Dysfunction ◽  
St Elevation Myocardial Infarction ◽  
St Elevation ◽  
The Impact
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