Abstract
Background
After the introduction of the universal definition of myocardial infarction, the incidence
and diagnosis of type 2 myocardial infarction have risen dramatically, yet there are
no clear guidelines on clinical management. Diabetic patients are at high risk for
developing type 2 myocardial infarction when admitted in a decompensated state, and
they are also at high risk for future cardiovascular events.
Methods
We performed a retrospective analysis of 1058 patients admitted with diabetic ketoacidosis
or hyperosmolar hyperglycemic state between 2011 and 2016. Patients were included
if they had cardiac troponin I measured within 24 hours of admission, were older than
18 years of age, and had no evidence of acute coronary syndrome on admission. Baseline
characteristics, admission laboratory test results, major adverse cardiovascular events,
cardiac stress testing, and coronary angiography data up to 1 year after admission
were reviewed. Patients were categorized into 2 groups: those with and those without
type 2 myocardial infarction. The study had 2 endpoints: mortality and major adverse
cardiac events (MACE) at 1 year and an abnormal result on stress test or coronary
angiography at 1 year.
Results
Of the 845 patients who met the inclusion criteria, 133 patients (15%) had type 2
myocardial infarction on admission. Patients with type 2 myocardial infarction were
at a significantly higher risk for mortality and MACE at 1 year than those without.
Patients with type 2 myocardial infarction were also at higher risk for developing
an abnormal result on stress test or coronary angiography within 1 year of admission
as compared with those without type 2 myocardial infarction (40% vs 24%; odds ratio 2;
P = .0699).
Conclusion
Acutely decompensated diabetic patients with type 2 myocardial infarction are at increased
risk for death and MACE. These patients may also be at risk for undiagnosed coronary
artery disease.
Keywords
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Article info
Publication history
Published online: March 05, 2018
Footnotes
Funding: None.
Conflict of Interest: None.
Authorship: All authors had access to the data and had roles in writing the manuscript.
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
