Table 1
Baseline demographic and clinical characteristics in the total group and by diabetes status.
| CHARACTERISTICS | TOTAL (n = 21374) | NO DIABETES (n = 11890) | DIABETES (n = 9484) | P-VALUE |
|---|---|---|---|---|
| Age, years, mean (SD) | 60.1 (12.0) | 59.3 (12.6) | 61.2 (11.2) | <0.001 |
| Male sex, n (%) | 16183 (75.7%) | 9482 (79.7%) | 6701 (70.7%) | <0.001 |
| History of diabetes, n (%) | 9484 (44.4%) | |||
| Current smoking, n (%) | 6614 (30.9%) | 4531 (38.1%) | 2083 (22.0%) | <0.001 |
| History of hypertension, n (%) | 10042 (47.0%) | 4172 (35.1%) | 5870 (61.9%) | <0.001 |
| Peripheral arterial disease, n (%) | 211 (1.0%) | 70 (0.6%) | 141 (1.5%) | <0.001 |
| Transferred from another facility, n (%) | 8401 (39.3%) | 4778 (40.2%) | 3623 (38.2%) | 0.003 |
| No insurance, n (%) | 15542 (72.7%) | 8306 (69.9%) | 7236 (76.3%) | <0.001 |
| STEMI, n (%) | 13689 (64.0%) | 8212 (69.1%) | 5477 (57.7%) | <0.001 |
| Symptoms onset-to-arrival, minutes, median (IQR) | 246.0 (118.0, 830.5) | 225.0 (115.0, 770.0) | 290.0 (120.0, 915.0) | <0.001 |
| Weight, mean (SD) | 63.4 (9.7) | 63.3 (9.8) | 63.6 (9.6) | 0.039 |
| Systolic BP, mm Hg, mean (SD) | 138.5 (29.0) | 137.1 (28.1) | 140.4 (29.9) | <0.001 |
| Heart rate, per minute, mean (SD) | 79.9 (18.9) | 78.1 (18.0) | 82.3 (19.8) | <0.001 |
| Killip class, n (%) | ||||
| I | 18459 (86.4%) | 10564 (88.9%) | 7895 (83.2%) | <0.001 |
| II | 1183 (5.5%) | 570 (4.8%) | 613 (6.5%) | |
| III | 1239 (5.8%) | 483 (4.1%) | 756 (8.0%) | |
| IV | 492 (2.3%) | 272 (2.3%) | 220 (2.3%) | |
| Troponin, ng/mL, median (IQR) | 1.3 (0.3, 5.8) | 1.4 (0.3, 6.3) | 1.2 (0.3, 5.5) | 0.021 |
| LDL-C, mg/dL, mean (SD) | 122.5 (40.9) | 125.3 (39.7) | 119.2 (42.2) | <0.001 |
| Triglycerides, mg/dL, median (IQR) | 121.0 (90.0, 165.0) | 119.0 (88.0, 161.0) | 124.0 (90.0, 170.0) | <0.001 |
| Serum Creatinine, mean (SD) | 1.2 (0.7) | 1.1 (0.5) | 1.2 (0.8) | <0.001 |
| Fasting glucose, mg/dL, mean (SD) | 148.0 (68.8) | 117.6 (41.9) | 179.8 (76.6) | <0.001 |
| Hemoglobin, mg/dL, mean (SD) | 13.2 (2.0) | 13.4 (2.0) | 13.0 (2.0) | <0.001 |
| Hospital type, n (%) | ||||
| Government | 7133 (33.4%) | 4582 (38.5%) | 2551 (26.9%) | <0.001 |
| Non-profit/Charity | 5749 (26.9%) | 2920 (24.6%) | 2829 (29.8%) | |
| Private | 8492 (39.7%) | 4388 (36.9%) | 4104 (43.3%) | |
| Hospital size, n (%) | ||||
| Extra Large (>1000 beds) | 3560 (16.7%) | 2405 (20.2%) | 1155 (12.2%) | <0.001 |
| Large (501–1000 beds) | 8523 (39.9%) | 4456 (37.5%) | 4067 (42.9%) | |
| Medium (201–500 beds) | 7415 (34.7%) | 4060 (34.1%) | 3355 (35.4%) | |
| Small (≤200 beds) | 1876 (8.8%) | 969 (8.1%) | 907 (9.6%) | |
| Catherization laboratory, n (%) | ||||
| Installed During Study | 496 (2.3%) | 312 (2.6%) | 184 (1.9%) | <0.001 |
| No | 3552 (16.6%) | 2261 (19.0%) | 1291 (13.6%) | |
| Yes | 17326 (81.1%) | 9317 (78.4%) | 8009 (84.4%) |
[i] Abbreviations: STEMI, ST-segment elevation myocardial infarction; BP, blood pressure; LDL-C, low-density lipoprotein cholesterol.
Table 2
Frequency of medication use, studies, and procedures during hospitalization and at discharge by diabetes status.
| MEASURE OF CARE | TOTAL (n = 21374) n (%) | NO DIABETES (n = 11890) n (%) | DIABETES (n = 9484) n (%) | P-VALUE |
|---|---|---|---|---|
| Medications | ||||
| Prehospital aspirin | 3796 (17.8%) | 1939 (16.3%) | 1857 (19.6%) | <0.001 |
| In-hospital aspirin | 20885 (97.9%) | 11644 (98.1%) | 9241 (97.7%) | 0.059 |
| In-hospital second antiplatelet | 20973 (98.2%) | 11673 (98.3%) | 9300 (98.2%) | 0.74 |
| In-hospital beta-blocker | 8314 (40.1%) | 4617 (40.0%) | 3697 (40.1%) | 0.82 |
| In-hospital anticoagulant | 18256 (85.6%) | 10221 (86.1%) | 8035 (84.9%) | 0.012 |
| Optimal in-hospital medications * | 7000 (33.8%) | 3971 (34.5%) | 3029 (33.0%) | 0.028 |
| Studies and procedures | ||||
| Echocardiography | 19725 (92.3%) | 10832 (91.1%) | 8893 (93.8%) | <0.001 |
| Diagnostic angiography | 12681 (59.3%) | 6989 (58.8%) | 5692 (60.0%) | 0.068 |
| PCI | 10553 (49.4%) | 6047 (50.9%) | 4506 (47.5%) | <0.001 |
| Primary PCI (for STEMI) | 6710 (49.0%) | 4022 (49.0%) | 2688 (49.1%) | 0.91 |
| Door-to-balloon time, min, median (IQR) (for STEMI) | 83.0 (57.0, 190.0) | 75.0 (55.0, 150.0) | 91.0 (60.0, 278.0) | <0.001 |
| Thrombolysis (for STEMI) | 3167 (23.1%) | 2006 (24.4%) | 1161 (21.2%) | <0.001 |
| Door-to-needle time, min, median (IQR) (for STEMI) | 44.0 (30.0, 70.0) | 43.0 (29.0, 66.0) | 45.0 (30.0, 80.0) | 0.002 |
| Any reperfusion (for STEMI) | 9872 (72.1%) | 6024 (73.4%) | 3848 (70.3%) | <0.001 |
| Rescue PCI (for STEMI) | 1675 (12.3%) | 1010 (12.3%) | 665 (12.2%) | 0.78 |
| Discharge treatments and counseling | ||||
| Discharge aspirin | 19137 (97.9%) | 10721 (98.0%) | 8416 (97.6%) | 0.048 |
| Discharge second antiplatelet | 19201 (98.0%) | 10739 (98.1%) | 8462 (97.9%) | 0.41 |
| Discharge beta-blocker | 12607 (66.1%) | 6968 (65.4%) | 5639 (66.9%) | 0.028 |
| Discharge statin | 18989 (97.0%) | 10597 (96.8%) | 8392 (97.2%) | 0.16 |
| Discharge ACE inhibitor or ARB | 9232 (48.1%) | 5228 (48.5%) | 4004 (47.6%) | 0.2 |
| Cardiac rehabilitation referral | 5684 (28.4%) | 3253 (29.1%) | 2431 (27.6%) | 0.02 |
| Optimal discharge medications ** | 11937 (63.0%) | 6617 (62.5%) | 5320 (63.6%) | 0.14 |
| Tobacco cessation advice | 6144 (95.5%) | 4242 (95.7%) | 1902 (95.0%) | 0.24 |
[i] Abbreviations: PCI, percutaneous coronary intervention; ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; STEMI, ST-segment elevation myocardial infarction.
* Includes the use of aspirin, adjuvant antiplatelet therapy [clopidogrel, prasugrel, or ticagrelor], anticoagulant, and β-blockers; in-hospital statin use was additionally predefined but data were not collected.
** Aspirin, adenosine diphosphate receptor antagonist [clopidogrel, prasugrel, or ticagrelor], statin, and β-blocker.
Figure 1
Frequency of in-hospital and 30-day adverse outcomes by diabetes status.
Table 3
Univariable and multivariable models for the association between diabetes and in-hospital and 30-day adverse outcomes.
| MODEL 1 | MODEL 2 | MODEL 3 | MODEL 4 | |||||
|---|---|---|---|---|---|---|---|---|
| OR (95% CI) | P-VALUE | OR (95% CI) | P-VALUE | OR (95% CI) | P-VALUE | OR (95% CI) | P-VALUE | |
| In Hospital outcomes | ||||||||
| Death | 1.50 (1.22 to 1.84) | <0.001 | 1.40 (1.12 to 1.76) | 0.004 | 1.46 (1.12 to 1.89) | 0.004 | NA | |
| Re-infarction | 1.47 (1.11 to 1.94) | 0.006 | 1.55 (1.15 to 2.10) | 0.004 | 1.52 (1.15 to 2.02) | 0.003 | NA | |
| Stroke | 1.08 (0.71 to 1.63) | 0.719 | 1.02 (0.67 to 1.53) | 0.938 | 1.00 (0.66 to 1.51) | 0.999 | NA | |
| Major bleeding* | 1.00 (0.42 to 2.40) | 0.995 | 0.87 (0.32 to 2.32) | 0.776 | 0.83 (0.31 to 2.23) | 0.717 | NA | |
| Heart failure | 1.53 (1.28 to 1.83) | <0.001 | 1.24 (1.04 to 1.46) | 0.013 | 1.26 (1.06 to 1.48) | 0.008 | NA | |
| Cardiogenic shock | 1.17 (0.91 to 1.50) | 0.213 | 1.18 (0.97 to 1.45) | 0.100 | 1.19 (0.96 to 1.48) | 0.105 | NA | |
| Cardiac arrest | 1.39 (1.13 to 1.72) | 0.002 | 1.29 (1.02 to 1.64) | 0.035 | 1.30 (1.03 to 1.64) | 0.026 | NA | |
| 30-day outcomes | ||||||||
| MACE** | 1.40 (1.22 to 1.62) | <0.001 | 1.29 (1.12 to 1.48) | <0.001 | 1.33 (1.14 to 1.55) | <0.001 | 1.28 (1.02 to 1.61) | 0.037 |
| Death | 1.46 (1.26 to 1.69) | <0.001 | 1.34 (1.14 to 1.59) | <0.001 | 1.40 (1.16 to 1.69) | <0.001 | 1.32 (0.96 to 1.81) | 0.090 |
| CVD death | 1.46 (1.26 to 1.68) | <0.001 | 1.34 (1.14 to 1.58) | 0.001 | 1.40 (1.16 to 1.69) | <0.001 | 1.28 (0.93 to 1.76) | 0.126 |
| Re-infarction | 1.41 (1.08 to 1.84) | 0.013 | 1.42 (1.10 to 1.84) | 0.007 | 1.44 (1.13 to 1.85) | 0.004 | 1.33 (0.94 to 1.89) | 0.105 |
| Stroke | 1.40 (0.95 to 2.05) | 0.087 | 1.31 (0.87 to 1.97) | 0.202 | 1.28 (0.86 to 1.92) | 0.222 | 1.05 (0.53 to 2.11) | 0.880 |
| Major bleeding* | 1.31 (0.76 to 2.25) | 0.335 | 1.19 (0.66 to 2.12) | 0.566 | 1.17 (0.67 to 2.04) | 0.584 | 0.92 (0.42 to 2.04) | 0.842 |
[i] Model 1: adjusted for clustering by center.
Model 2: adjusted for factor in Model 1 plus age, sex, smoking status, presence of STEMI, systolic blood pressure, heart rate, Killip class on presentation.
Model 3: adjusted for factors in Model 2 plus administration of aspirin and anticoagulation therapy on admission, PCI during admission, randomization arm.
Model 4: adjusted for factors in Model 3 plus discharge aspirin, second antiplatelet, beta-blocker, ACE inhibitor or ARB, statin, and referral to cardiac rehabilitation. Model 4 only included those who survived their hospitalization.
* Major bleeding defined as defined by the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] criteria,16 which is defined by intracerebral hemorrhage or bleeding resulting in substantial hemodynamic compromise requiring treatment.
** Defined as death, reinfarction (defined by the Third Universal Definition of Myocardial Infarction13), stroke, and major bleeding (defined by the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries [GUSTO] criteria,16 which is defined by intracerebral hemorrhage or bleeding resulting in substantial hemodynamic compromise requiring treatment).
Figure 2
Multivariable adjusted odds ratios for the association between diabetes and 30-day MACE after myocardial infarction in selected subgroups. Abbreviations: PCI, percutaneous coronary intervention; STEMI, ST-segment elevation myocardial infarction. Adjusted OR were calculated using a cluster-adjusted multivariable logistic model which included age, sex, smoking status, presence of STEMI, systolic blood pressure, heart rate, Killip class on presentation, administration of aspirin, and anticoagulation therapy on admission, PCI during admission, randomization arm.