Addressing disparities in the long-term mortality risk in individuals with non-ST segment myocardial infarction (NSTEMI) by diabetes mellitus status: a nationwide cohort study

Cole, Andrew; Weight, Nicholas; Mishra, Shivani; Grapsa, Julia; Rutter, Martin K; Siudak, Zbigniew; Moledina, Saadiq; Kontopantelis, Evangelos; Khunti, Kamlesh; Mamas, Mamas A

Abstract

Aims/hypothesis
The aim of this study was to investigate how diabetes mellitus affects longer term outcomes in individuals presenting to hospital with non-ST segment elevation myocardial infarction (NSTEMI).

Methods
We analysed data from 456,376 adults hospitalised between January 2005 and March 2019 with NSTEMI from the UK Myocardial Ischaemia National Audit Project (MINAP) registry, linked with Office for National Statistics death reporting. We compared outcomes and quality of care by diabetes status.

Results
Individuals with diabetes were older (median age 74 vs 73 years), were more often of Asian ethnicity (13% vs 4%) and underwent revascularisation (percutaneous coronary intervention or coronary artery bypass graft surgery) (38% vs 40%) less frequently than those without diabetes. The mortality risk for those with diabetes compared with those without was significantly higher at 30 days (HR 1.19, 95% CI 1.15, 1.23), 1 year (HR 1.28, 95% CI 1.26, 1.31), 5 years (HR 1.36, 95% CI 1.34, 1.38) and 10 years (HR 1.39, 95% CI 1.36, 1.42). In individuals with diabetes, higher quality inpatient care, assessed by opportunity-based quality indicator (OBQI) score category (‘poor’, ‘fair’, ‘good’ or ‘excellent’), was associated with lower mortality rates compared with poor care (good: HR 0.74, 95% CI 0.73, 0.76; excellent: HR 0.69, 95% CI 0.68, 0.71). In addition, compared with poor care, excellent care in the diabetes group was associated with the lowest mortality rates in the diet-treated and insulin-treated subgroups (diet-treated: HR 0.64, 95% CI 0.61, 0.68; insulin-treated: HR 0.69, CI 0.66, 0.72).

Conclusion/interpretation
Individuals with diabetes experience disparities during inpatient care following NSTEMI. They have a higher risk of long-term mortality than those without diabetes, and higher quality inpatient care may lead to better long-term survival.

Citation

Cole, A., Weight, N., Mishra, S., Grapsa, J., Rutter, M. K., Siudak, Z., Moledina, S., Kontopantelis, E., Khunti, K., & Mamas, M. A. (in press). Addressing disparities in the long-term mortality risk in individuals with non-ST segment myocardial infarction (NSTEMI) by diabetes mellitus status: a nationwide cohort study. Diabetologia, https://doi.org/10.1007/s00125-024-06281-7

• Journal Article Type: Article
• Acceptance Date: Aug 6, 2024
• Online Publication Date: Oct 3, 2024
• Deposit Date: Oct 11, 2024
• Journal: Diabetologia
• Print ISSN: 0012-186X
• Electronic ISSN: 1432-0428
• Publisher: Springer Verlag
• Peer Reviewed: Peer Reviewed
• DOI: https://doi.org/10.1007/s00125-024-06281-7
• Keywords: Mortality, Non-ST elevation myocardial infarction, Quality of care, Acute myocardial infarction, Cardiovascular epidemiology, Diabetes mellitus
• Public URL: https://keele-repository.worktribe.com/output/950303
• Publisher URL: https://link.springer.com/article/10.1007/s00125-024-06281-7
• Additional Information: Received: 17 April 2024; Accepted: 6 August 2024; First Online: 3 October 2024; : The data underlying this article were provided by the National Institute for Cardiovascular Outcomes Research (NICOR). Data will be shared on request to the corresponding author with the permission of NICOR.; : This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.; : The authors declare that there are no relationships or activities that might bias, or be perceived to bias, their work.; : All authors made substantial contributions to the conception or design of the work or the acquisition, analysis or interpretation of data; and drafting or reviewing the article critically for important intellectual content. All authors approved the final version to be published. MAM is responsible for the integrity of the work as a whole.