Background: ST-segment elevation myocardial infarction (STEMI) patients with diabetes mellitus (DM) have higher in-hospital mortality than those without. Since cardiac and renal functions are the main variables associated with outcome in STEMI, we hypothesized that this prognostic disparity may depend on a higher rate of cardiac and renal dysfunction in DM patients.

Methods: We included 5,152 STEMI patients treated with primary angioplasty. Left ventricular ejection fraction (LVEF) and estimated glomerular filtration rate (eGFR) were evaluated at hospital admission. The primary endpoint was in-hospital mortality. A composite of in-hospital mortality, cardiogenic shock, and acute kidney injury was the secondary endpoint.

Results: Eight-hundred-seventy-nine (17%) patients had DM. The incidence of LVEF≤40% (30% vs. 22%; P<0.001), eGFR≥60 ml/min/1.73m2 (27% vs. 18%; P<0.001), or both (12% vs. 6%; P<0.001) was higher in patients with DM. In-hospital mortality was higher in DM than in non-DM patients (6.1% vs. 3.5%; P=0.002) with an unadjusted OR of 1.81 (95% confidence interval [CI] 1.31-2.50; P=0.003). However, DM was no longer associated with an increased mortality risk after adjustment for cardiac and renal function (OR 1.03, 95% CI 0.68-1.56; P=0.89). A similar behavior was observed for the secondary endpoint, with an unadjusted OR for DM of 1.52 (95% CI 1.25-1.85; P<0.001) and an OR after adjustment for cardiac and renal function of 1.07 (95% CI 0.85-1.36; P=0.53).

Conclusion: The study indicates that the increased in-hospital mortality and morbidity of DM patients with STEMI is driven by the underlying cardio-renal dysfunction, rather than to the mere presence of DM.


S. Genovese: Advisory Panel; Self; Novartis Pharmaceuticals Corporation, Sanofi. Consultant; Self; AstraZeneca, Boehringer Ingelheim Pharmaceuticals, Inc., Hikma Pharmaceuticals. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Mundipharma, Novo Nordisk A/S, Takeda Pharmaceutical Company Limited. N. Cosentino: None. J. Campodonico: None. M. De Metrio: None. M. Moltrasio: None. M. Rondinelli: Consultant; Self; Sanofi. Speaker's Bureau; Self; Eli Lilly and Company, Merck Sharp & Dohme Corp., Takeda Pharmaceutical Company Limited. G. De Ferrari: None. G. Marenzi: Speaker's Bureau; Self; Merck Sharp & Dohme Corp.


Centro Cardiologico Monzino

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. More information is available at