The Association between Acute Heart Failure, Mortality and Duration of Type 2 Diabetes Mellitus in STEMI Patients

Background In patients with Type 2 Diabetes Mellitus, the decrease in insulin sensitivity predisposes for impaired myocardial structure and function and it partly explains the increased prevalence in Heart Failure in this population. The Metabolic Memory, a phenomenon related to the prolonged harm produced by hyperglycemia, explains why macrovascular and microvascular damages continue despite intensive glycemic control in diabetics. Hyperglycemia in ST-Segment Elevation Myocardial Infarction (STEMI) worsens endothelial dysfunction, oxidative stress and vascular inflammation. This way, Type 2 Diabetes Mellitus (DM) patients with STEMI have a worse short-term prognosis than non-diabetics. There is limited information regarding the impact of DM duration on Acute Heart Failure (AHF) and mortality in patients with STEMI. Aim This study aims at evaluating the development of Acute Heart Failure and mortality in STEMI patients and the impact of Diabetes Mellitus duration. Methods We enrolled all Type 2 Diabetes Mellitus patients admitted with STEMI to the Cardiac Intensive Care Unit in UHC Mother Teresa, Tirana, between September 2012 and September 2016 who presented in the first six to twelve hours of chest pain. Diabetic patients were divided in three groups new onset, under treatment with oral antidiabetic drugs (OAD) and under treatment with insulin before admission, and we gathered data regarding glycemia at admission, smoking, age, gender, ethnicity, hypertension, type of Myocardial Infarction (MI), treatment method and we studied in-hospital Acute Heart Failure and mortality. Results We enrolled 290 patients in total, out of which 67 (23.10 %) had new onset DM, 161 (55.50 %) were being treated with OAD and 62 (21.4 %) were being treated with insulin. Total mortality was 15.20 %. There was a higher mortality, although not statistically significant (p=0.068) in the insulin group (24.20 %), compared to the new-onset group (10.40 %) and OAD group (13.70 %). Acute Heart Failure developed in 39 % of cases in total and it was statistically significantly higher in the insulin group (54.8 %/p=0.008), compared to the new-onset group (40.30 %) and OAD group (32.30 %). Conclusion Type 2 Diabetes Mellitus duration is an important factor in the short-term prognosis of STEMI patients regarding the development of Acute Heart Failure and mortality.