| The inter-relationship of diabetes and left ventricular systolic function on outcome after high-risk myocardial infarction. | |
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MedLine Citation:
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PMID: 20965879 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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AIMS: Diabetes is a potent risk factor for death and heart failure (HF) hospitalization following myocardial infarction (MI). Whether diabetes modifies the relationship between left ventricular ejection fraction (LVEF) and outcomes in the post-MI population is unknown. METHODS AND RESULTS: The Valsartan in Acute Myocardial Infarction trial (VALIANT) enrolled 14 703 patients with acute MI complicated by HF, systolic dysfunction, or both. We compared the risk of death, HF hospitalization, and/or recurrent MI among patients with and without diabetes using Cox proportional hazards models. To assess the relationship between diabetes, LVEF and outcomes, we assessed the relative influence of baseline LVEF on outcomes in diabetic and non-diabetic patients. Totally, 11 325 subjects (3095 diabetics) with site-reported LVEF and known diabetes status were included. At any given LVEF, diabetes was associated with a higher risk of all-cause mortality [adjusted hazard ratio (HR) 1.37, 95% CI 1.25-1.51], death or HF hospitalization (adjusted HR 1.42, 95% CI 1.31-1.51), and death or recurrent MI (adjusted HR 1.36, 95% CI 1.24-1.48). Diabetes modified the relationship between LVEF and death or HF hospitalization (P for interaction = 0.0109), such that the association between diabetes and increased risk was greater in magnitude at higher LVEF. No interaction was noted between diabetes and LVEF on risk of all-cause mortality or death or recurrent MI. CONCLUSION: Diabetes is associated with a higher risk of death or HF hospitalization across the spectrum of LVEF in high-risk post-MI patients. The magnitude of reduction in risk of death or HF hospitalization associated with increasing LVEF is significantly attenuated among patients with diabetes when compared to patients without diabetes. |
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Authors:
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Amil M Shah; Hajime Uno; Lars Køber; Eric J Velazquez; Aldo P Maggioni; Michael R MacDonald; Mark C Petrie; John J V McMurray; Robert M Califf; Marc A Pfeffer; Scott D Solomon |
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Publication Detail:
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Type: Journal Article; Randomized Controlled Trial |
Journal Detail:
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Title: European journal of heart failure Volume: 12 ISSN: 1879-0844 ISO Abbreviation: Eur. J. Heart Fail. Publication Date: 2010 Nov |
Date Detail:
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Created Date: 2010-10-22 Completed Date: 2011-03-14 Revised Date: 2011-06-08 |
Medline Journal Info:
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Nlm Unique ID: 100887595 Medline TA: Eur J Heart Fail Country: Netherlands |
Other Details:
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Languages: eng Pagination: 1229-37 Citation Subset: IM |
Affiliation:
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Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02445, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Diabetic Angiopathies / complications, mortality, physiopathology* Female Heart Failure / etiology, mortality, physiopathology* Hospitalization / statistics & numerical data Humans Male Middle Aged Myocardial Infarction / complications, mortality, physiopathology* Proportional Hazards Models Recurrence Risk Assessment Stroke Volume* Ventricular Function, Left / physiology* |
| Comments/Corrections | |
Comment In:
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Eur J Heart Fail. 2010 Nov;12(11):1156-8
[PMID:
20965878
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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