OBJECTIVE

To study prognosis after a first-ever myocardial infarction (MI) in type 1 diabetes, as well as how different MI- and diabetes-related factors affect the prognosis and risk of secondary cardiovascular events.

RESEARCH DESIGN AND METHODS

In this observational follow-up study of 4,217 individuals from the Finnish Diabetic Nephropathy (FinnDiane) Study with no prior MI or coronary revascularization, we verified 253 (6.0%) MIs from medical records or death certificates. Mortality from cardiovascular or diabetes-related cause was our main end point, whereas hospitalization due to heart failure, coronary revascularization, and recurrent MI were secondary end points, while accounting for death as a competing risk.

RESULTS

Of the individuals studied, 187 (73.9%) died during the median post-MI follow-up of 3.07 (interquartile range 0.02–8.45) years. Independent risk factors for cardiovascular and diabetes-related mortality were estimated glomerular filtration rate categories grade 3 (G3) (hazard ratio [HR] 3.27 [95% CI 1.76–6.08]), G4 (3.62 [1.69–7.73]), and G5 (4.03 [2.24–7.26]); prior coronary heart disease diagnosis (1.50 [1.03–2.20]); and older age at MI (1.03 [1.00–1.05]). Factors associated with lower mortality were acute revascularization (HR 0.35 [95% CI 0.18–0.72]) and subacute revascularization (0.39 [0.26–0.59]). In Fine and Gray competing risk analyses, kidney failure was associated with a higher risk of recurrent MI (subdistribution HR 3.27 [95% CI 2.01–5.34]), heart failure (3.76 [2.46–5.76]), and coronary revascularization (3.04 [1.89–4.90]).

CONCLUSIONS

Individuals with type 1 diabetes have a high cardiovascular and diabetes-related mortality after their first-ever MI. In particular, poor kidney function is associated with high mortality and excessive risk of secondary cardiovascular events.

ARTICLE HIGHLIGHTS

  • The prognosis and factors affecting the prognosis after a first-ever myocardial infarction in type 1 diabetes is unknown.

  • We aimed to assess the prognosis and identify factors associated with mortality and risk for secondary cardiovascular events.

  • Individuals with type 1 diabetes have a poor survival after their first-ever myocardial infarction. Chronic kidney disease was associated with higher mortality and risk of secondary events. Younger age at myocardial infarction and coronary revascularization during hospitalization were associated with lower mortality.

  • Prevention of kidney disease is important to improve the prognosis in type 1 diabetes, both before and after a myocardial infarction.

This article contains supplementary material online at https://doi.org/10.2337/figshare.21396999.

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