Diabetes Mellitus and Cardiogenic Shock Complicating Acute Myocardial Infarction.
BACKGROUND
Diabetes mellitus (diabetes) increases the risk of acute myocardial infarction, which can result in cardiogenic shock. Data on the relation of diabetes and the occurrence and prognosis of cardiogenic shock postacute myocardial infarction are scant.


METHODS
Among the National Inpatient Sample patients aged ≥18 years and hospitalized for acute myocardial infarction during the 2012-2014 period, we examined the association between diabetes and the incidence and outcomes of cardiogenic shock complicating acute myocardial infarction, using multivariable logistic and linear regression models.


RESULTS
Of 1,332,530 hospitalizations for acute myocardial infarction, 72,765 (5.5%) were complicated by cardiogenic shock. In acute myocardial infarction patients, cardiogenic shock incidence was higher among those with vs without diabetes (5.8% vs 5.2%; adjusted odds ratio [aOR] 1.14; 95% confidence interval [CI], 1.11-1.19; P < .001), with 42.8% (n = 31,135) of patients with acute myocardial infarction and cardiogenic shock having diabetes. Diabetic patients were less likely to undergo revascularization (percutaneous coronary intervention or coronary artery bypass grafting) (67.1% vs 68.7%; aOR 0.88; 95% CI, 0.80-0.96; P = .003). Diabetes was associated with higher in-hospital mortality in patients with acute myocardial infarction and cardiogenic shock (37.9% vs 36.8%; aOR 1.18; 95% CI, 1.09-1.28; P < .001). Among survivors, patients with diabetes had a longer hospital stay (mean ± SEM: 11.6 ± 0.16 vs 10.9 ± 0.16 days; adjusted estimate 1.12; 95% CI, 1.06-1.18; P < .001) and were more likely to be discharged to a skilled nursing home or with home health care (56.0% vs 50.5%; aOR 1.19; 95% CI, 1.07-1.33; P = .001).


CONCLUSIONS
In a large cohort of acute myocardial infarction patients, preexisting diabetes was associated with an increased risk of cardiogenic shock and worse outcomes in those with cardiogenic shock.
['Echouffo-Tcheugui|Justin B|JB|', 'Kolte|Dhaval|D|', 'Khera|Sahil|S|', 'Aronow|Herbert D|HD|', 'Abbott|J Dawn|JD|', 'Bhatt|Deepak L|DL|', 'Fonarow|Gregg C|GC|']
D000368:Aged D058065:Diabetic Cardiomyopathies D005260:Female D017052:Hospital Mortality D006801:Humans D007902:Length of Stay D008297:Male D009203:Myocardial Infarction D011379:Prognosis D012189:Retrospective Studies D012307:Risk Factors D012770:Shock, Cardiogenic D016896:Treatment Outcome
Diabetes mellitus Cardiogenic shock Myocardial infarction Mortality