Abstract
BackgroundThe comparative clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) in older adults with AMI in the era of newer-generation drug-eluting stents (DES) are limited. We investigated the 2-year clinical outcomes of these patients.MethodsA total of 5492 AMI patients aged ≥65 years were classified into three groups according to their glycemic status: normoglycemia (group A: 1193), prediabetes (group B: 1696), and T2DM (group C: 2603). The primary outcome was the occurrence of major adverse cardiac events (MACE), defined as all-cause death, recurrent myocardial infarction (Re-MI), and any repeat revascularization. The secondary outcome was stent thrombosis (ST).ResultsThe primary and secondary outcomes cumulative incidences were similar between the prediabetes and T2DM groups. In both the prediabetes and T2DM groups, the cumulative incidences of MACE (adjusted hazard ratio [aHR]: 1.373; p = 0.020 and aHR: 1.479; p = 0.002, respectively) and all-cause death or MI (aHR: 1.436; p = 0.022 and aHR: 1.647; p = 0.001, respectively) were significantly higher than those in the normoglycemia group. Additionally, the cumulative incidence of all-cause death in the T2DM group was significantly higher than that in the normoglycemia group (aHR, 1.666; p = 0.003).ConclusionsIn this retrospective study, despite the 2-year clinical outcomes of the patients with prediabetes and T2DM in the older adults were worse than those in the normoglycemia group; they were similar between the prediabetes and T2DM groups. Hence, comparable treatment strategies should be strengthened between prediabetes and T2DM in older adults with AMI.Trial registrationRetrospectively registered.
Highlights
The comparative clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) in older adults with acute myocardial infarction (MI) (AMI) in the era of newer-generation drug-eluting stents (DES) are limited
Yang et al [12] demonstrated that fasting plasma glucose (FPG) levels were associated with a higher risk of in-hospital mortality in 1854 elderly patients with acute MI (AMI)
The mean value of the left ventricular ejection fraction (LVEF) was more than 50%, which was the highest in the prediabetes group
Summary
The comparative clinical outcomes between prediabetes and type 2 diabetes mellitus (T2DM) in older adults with AMI in the era of newer-generation drug-eluting stents (DES) are limited. The number of DM cases is expected to reach 642 million by 2040 worldwide [1] Of those aged 65 years and above, an estimated 22–33% had diabetes [2,3,4] or more than 20% had impaired glucose regulation [5]. Yang et al [12] demonstrated that fasting plasma glucose (FPG) levels were associated with a higher risk of in-hospital mortality in 1854 elderly (aged ≥65 years) patients with AMI. Another study suggested that patients with prediabetes and normoglycemia had similar 1-year mortality rates (adjusted odds ratio: 0.90; 95% CI: 0.66–1.24) in their 8795 high-risk non-ST-segment elevation myocardial infarction (NSTEMI) patients [16]. To clarify the comparative clinical outcomes between prediabetes and T2DM in older adults and to reflect contemporary trends of percutaneous coronary intervention (PCI), we compared the 2-year clinical outcomes between prediabetes and T2DM in older adults with AMI who underwent successful implantation of newer-generation drug-eluting stents (DES)
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