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Long-term excess mortality associated with diabetes following acute myocardial infarction: a population-based cohort study.
Alabas, O A; Hall, M; Dondo, T B; Rutherford, M J; Timmis, A D; Batin, P D; Deanfield, J E; Hemingway, H; Gale, C P.
Afiliación
  • Alabas OA; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Hall M; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Dondo TB; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
  • Rutherford MJ; Department of Health Sciences, University of Leicester, Leicester, UK.
  • Timmis AD; The National Institute for Health Biomedical Research Unit, Barts Health, London, UK.
  • Batin PD; Department of Cardiology, The Mid Yorkshire Hospitals NHS Trust, Wakefield, UK.
  • Deanfield JE; National Institute for Cardiovascular Outcomes Research, University College London, London, UK.
  • Hemingway H; The Farr Institute, University College London, London, UK.
  • Gale CP; Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK.
J Epidemiol Community Health ; 71(1): 25-32, 2017 01.
Article en En | MEDLINE | ID: mdl-27307468
BACKGROUND: The long-term excess risk of death associated with diabetes following acute myocardial infarction is unknown. We determined the excess risk of death associated with diabetes among patients with ST-elevation myocardial infarction (STEMI) and non-STEMI (NSTEMI) after adjustment for comorbidity, risk factors and cardiovascular treatments. METHODS: Nationwide population-based cohort (STEMI n=281 259 and NSTEMI n=422 661) using data from the UK acute myocardial infarction registry, MINAP, between 1 January 2003 and 30 June 2013. Age, sex, calendar year and country-specific mortality rates for the populace of England and Wales (n=56.9 million) were matched to cases of STEMI and NSTEMI. Flexible parametric survival models were used to calculate excess mortality rate ratios (EMRR) after multivariable adjustment. This study is registered at ClinicalTrials.gov (NCT02591576). RESULTS: Over 1.94 million person-years follow-up including 120 568 (17.1%) patients with diabetes, there were 187 875 (26.7%) deaths. Overall, unadjusted (all cause) mortality was higher among patients with than without diabetes (35.8% vs 25.3%). After adjustment for age, sex and year of acute myocardial infarction, diabetes was associated with a 72% and 67% excess risk of death following STEMI (EMRR 1.72, 95% CI 1.66 to 1.79) and NSTEMI (1.67, 1.63 to 1.71). Diabetes remained significantly associated with substantial excess mortality despite cumulative adjustment for comorbidity (EMRR 1.52, 95% CI 1.46 to 1.58 vs 1.45, 1.42 to 1.49), risk factors (1.50, 1.44 to 1.57 vs 1.33, 1.30 to 1.36) and cardiovascular treatments (1.56, 1.49 to 1.63 vs 1.39, 1.36 to 1.43). CONCLUSIONS: At index acute myocardial infarction, diabetes was common and associated with significant long-term excess mortality, over and above the effects of comorbidities, risk factors and cardiovascular treatments.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Infarto del Miocardio Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: J Epidemiol Community Health Año: 2017 Tipo del documento: Article Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Diabetes Mellitus / Infarto del Miocardio Tipo de estudio: Etiology_studies / Observational_studies / Prognostic_studies / Risk_factors_studies Límite: Aged / Female / Humans / Male País/Región como asunto: Europa Idioma: En Revista: J Epidemiol Community Health Año: 2017 Tipo del documento: Article Pais de publicación: Reino Unido