Diabetes and Its Impact on Cardiogenic Shock Outcomes in Acute Myocardial Infarction with Polyvascular Disease: A Comparative Analysis

Abstract

Background: Diabetes mellitus (DM) significantly impacts cardiovascular outcomes, particularly in patients with acute myocardial infarction (AMI) complicated by cardiogenic shock (CS). The presence of polyvascular disease further complicates the prognosis due to the increased burden of atherosclerosis and comorbidities. This study was designed to investigate the combined impact of DM and polyvascular disease on outcomes in patients with AMI and CS.

Method: Using the National Inpatient Sample database, we analyzed 39,140 patients with AMI complicated by CS and known polyvascular disease. The patients were stratified by diabetes status. The study assessed in-hospital major adverse cardiovascular and cerebrovascular events (MACCE), mortality, cerebrovascular accident (CVA) and major bleeding. Multivariable logistic regression models were used to examine the association between in-hospital outcomes and diabetes, adjusting for baseline differences.

Results: Of the study population, 54% had DM. The patients with DM were younger (69.5 vs. 72.1 years, p < 0.001) and more likely to be female (36.7% vs. 34.2%, p < 0.001). After adjustment, the patients with DM showed a 17% increased mortality risk (aOR 1.17, 95% CI: 1.11-1.23, p < 0.001) and a higher risk of major adverse cardiovascular and cerebrovascular events (aOR 1.05, 95% CI: 1.01-1.10, p = 0.020).

Conclusions: DM significantly impacts outcomes in patients with AMI complicated by CS and polyvascular disease, leading to increased mortality risk, longer hospital stays, and higher healthcare costs. These findings underscore the need for targeted interventions and specialized care strategies for this high-risk population.

Keywords: acute myocardial infarction; cardiogenic shock; diabetes mellitus; outcomes; poly-vascular disease.

Figure 1

Flow Diagram.

Figure 2

Disposition of patients based on diagnosis of diabetes.

Figure 3

Adjusted odds ratio for in-hospital procedure complications in acute myocardial infarction patients with diabetes mellitus and polyvascular disease complicated by cardiogenic shock. Reference: no DM; adjusted for age, gender, hospital bed size, region and location/teaching status, STEMI, CABG, PCI, angiography, thrombolysis, mechanical ventilation, circulatory support, VF, VT, AF, HF, hypertension, valvular heart disease, smoking status, chronic liver disease, anemia, thrombocytopenia, coagulopathies, and malignancies.