Relation of Extracardiac Vascular Disease and Outcomes in Patients With Diabetes (1.1 Million) Hospitalized for Acute Myocardial Infarction

The association between vascular disease and outcomes of acute myocardial infarction (AMI) patients has not been well-defined in the diabetes mellitus (DM) population. All DM patients presenting with AMI between October 2015 and December 2018 in the National Inpatient Sample database were stratified by number and site of extra-cardiac vascular comorbidity (cerebrovascular (CeVD), renovascular, neural, retinal and peripheral (PAD)). Multivariable logistic regression was used to determine the adjusted odds ratios (aOR) of in-hospital adverse outcomes and procedures. Of 1,116,670 patients with DM hospitalized for AMI, 366,165 (32.8%) had ≥1 extra-cardiac vascular comorbidity. Patients with vascular disease had increased aOR of mortality (aOR 1.05, 95%CI 1.04-1.07), major adverse cardiovascular and cerebrovascular events (MACCE) (aOR 1.19, 95%CI 1.18-1.21), stroke (aOR 1.72, 95%CI 1.68-1.76) and major bleeding (aOR 1.11, 95%CI 1.09-1.13), and had lower odds of receiving coronary angiography (CA) (aOR 0.90, 95%CI 0.90-0.91) and percutaneous coronary intervention (PCI) (aOR 0.82, 95%CI 0.82-0.83) compared to patients without extra-cardiac vascular disease. Patients with PAD had the highest odds of mortality (aOR 1.29, 95%CI 1.27-1.32) whereas CeVD patients had the greatest odds of MACCE, stroke and major bleeding (aOR 1.82, 95%CI 1.78-1.87, aOR 4.25, 95%CI 4.10-4.40, and aOR 1.51, 95%CI 1.45-1.57, respectively). Patients with DM presenting with AMI and concomitant extra-cardiac vascular disease were more likely to develop clinical outcomes and less likely to undergo CA or PCI. PAD patients had the highest risk of mortality, while CeVD patients had the greatest risk of MACCE, stroke and major bleeding.