Korean J Intern Med.  2024 Jan;39(1):110-122. 10.3904/kjim.2023.307.

Time to presentation and mortality outcomes among patients with diabetes and acute myocardial infarction

• Shin MA
• Oh S
• Kim MC
• Sim DS
• Hong YJ
• Kim JH
• Ahn Y
• Jeong MH

• KMID: 2550045
• DOI: http://doi.org/10.3904/kjim.2023.307

Abstract

Background/Aims
Due to limited real-world evidence on the association between time to presentation (T2P) and outcomes following acute myocardial infarction and diabetes (AMI-DM), we investigated the characteristics of patients with AMI-DM and their outcomes based on their T2P.
Methods
4,455 patients with AMI-DM from a Korean nationwide observational cohort (2011–2015) were divided into early and late presenters according to symptom-to-door time. The effects of T2P on three-year all-cause mortality were estimated using inverse probability of treatment weighting (IPTW) and survival analysis.
Results
The incidence of all-cause mortality was consistently higher in late presenters than in early presenters (11.4 vs. 17.2%; p < 0.001). In the IPTW-adjusted dataset, the incidence of all-cause mortality was numerically higher in late presenters than in early presenters (9.1 vs. 12.4%; p = 0.072). In the survival analysis, the cumulative incidence of all-cause mortality was significantly higher in late presenters than in early presenters before and after IPTW. In the subgroup with ST-elevation myocardial infarction, late presenters had a higher incidence of cardiac death than early presenters before (4.8 vs. 10.5%; p < 0.001) and after IPTW (4.2 vs. 9.7%; p = 0.034). In the initial glycated hemoglobin (HbA1c)-stratified analysis, these effects were attenuated in patients with HbA1c ≥ 9.0% before (adjusted hazard ratio [HR]: 1.45, 95% confidence interval [CI]: 0.80-2.64) and after IPTW (adjusted HR: 0.82, 95% CI: 0.40-1.67).
Conclusions
Late presentation was associated with higher mortality in patients with AMI-DM; therefore, multifaceted and systematic interventions are needed to decrease pre-hospital delays.

Keyword

Comparative study; Diabetes mellitus; Myocardial infarction; Treatment delays; Treatment outcome