Abstract 12102: Concomitance of Diabetes Mellitus and Prior Myocardial Infarction Associated With Poor Clinical Outcomes in Patients With Atrial Fibrillation: The Fushimi AF Registry

Abstract

Background : Patients with diabetes mellitus (DM) have high risk of cardiovascular events such as cardiovascular death, stroke, heart failure and so on. Patients with history of myocardial infarction (MI) are also at high risk. The outcomes of patients with nonvalvular atrial fibrillation (NVAF) who have both DM and history of MI are unclear. Methods : From the Fushimi AF registry, we obtained NVAF patients who had both DM and history of MI (DM+MI+: N=107), either DM or history of MI (DM-MI+: N=156, and DM+MI-: (N=935), and neither DM nor history of MI (DM-MI-: N=3,197). Major adverse cardiovascular and cerebrovascular events (MACCE) and all-cause mortality were evaluated. MACCE was defined as composite events of cardiovascular death, myocardial infarction, stroke, and admission for heart failure. Results: The median follow-up period was 1,851 (interquartile range: 790-2,924) days. DM+MI+ patients were often male and had more heart failure, chronic renal disease, dyslipidemia, hypertension, and paroxysmal AF than other patients. DM+MI+patients had also higher risk scores (CHADS 2 , CHA 2 DS 2 -VASc and HAS-BLED scores). DM+MI+ patients had significantly higher incidence (% per patient-year) of MACCE and all-cause mortality than others (Figure A and B. MACCE: DM+MI+ 18.8%, DM-MI+ 8.0%, DM+MI- 6.1%, DM-/MI- 4.9%, log rank P<0.001, all-cause mortality: 10.2%, 6.1%, 5.2%, 4.5%, respectively, log rank P<0.001). In multivariate analysis, DM+MI+ was significantly associated with the incidence of MACCE compared with DM-/MI- (adjusted hazard ratio [95% confidence interval], 1.97 [1.36-2.87], P<0.001), although DM-MI+ and DM+MI had no association with it. In addition, DM+MI+ had no significant association with the incidence of all-cause mortality after multivariate adjustment. Conclusion: Patients with NVAF who have both DM and history of MI had more comorbidities and had significant association with adverse cardiovascular events.