Sudden cardiac death after myocardial infarction in patients with type 2 diabetes

M. Juhani Junttila, Petra Barthel, Robert J. Myerburg, Timo H. Mäkikallio, Axel Bauer, Kurt Ulm, Antti Kiviniemi, Mikko Tulppo, Juha S. Perkiömki, Georg Schmidt, Heikki V. Huikuri

Research output: Contribution to journalArticle

61 Scopus citations

Abstract

Background: Type 2 diabetes mellitus is a well-established risk factor for atherosclerosis, but its contribution to sudden cardiac death (SCD) risk after myocardial infarction (MI) is not well defined. Objective: The purpose of this study was to compare the incidence and time-dependent risk of SCD in diabetic patients versus nondiabetic patients during 5-year follow-up after acute MI. Methods: A total of 3,276 patients were enrolled at the time of acute MI between 1996 and 2005. Mean age at entry was 60 ± 11 years, and the cohort was followed until 2009. At entry into the study, diabetes was present in 629 (19.2%) patients. The primary endpoint was SCD, and the secondary endpoints were non-SCD and all-cause mortality. Results: Among diabetic patients, the incidence of SCD was higher (5.9%) than in nondiabetic patients (1.7%), with a hazard ratio (HR) of 3.8 (95% confidence interval [CI] 2.45.8; P <.001) and adjusted HR of 2.3 (95% CI 1.43.8; P <.01). In diabetic patients with left ventricular ejection fraction >35%, the incidence of SCD was nearly identical to that of nondiabetic patients with ventricular ejection fraction ≤35% (4.1% vs 4.9%; P = .48). An excess in the incidence of non-SCD began to appear among diabetic patients within the first 6 months of follow-up (P <.001) but not in the incidence of SCD (P = .09). The excess in SCD among diabetic patients began to appear more than 6 months after the index event. Conclusion: Patients with type 2 diabetes are at higher risk for SCD after MI than are nondiabetic patients. The incidence of SCD in post-MI type 2 diabetic patients with left ventricular ejection fraction >35% is equal to that of nondiabetic patients with left ventricular ejection fraction <35%.

Original languageEnglish (US)
Pages (from-to)1396-1403
Number of pages8
JournalHeart rhythm
Volume7
Issue number10
DOIs
StatePublished - Oct 1 2010

Keywords

  • Diabetes Mellitus
  • Myocardial infarction
  • Prognosis
  • Sudden deat

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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    Junttila, M. J., Barthel, P., Myerburg, R. J., Mäkikallio, T. H., Bauer, A., Ulm, K., Kiviniemi, A., Tulppo, M., Perkiömki, J. S., Schmidt, G., & Huikuri, H. V. (2010). Sudden cardiac death after myocardial infarction in patients with type 2 diabetes. Heart rhythm, 7(10), 1396-1403. https://doi.org/10.1016/j.hrthm.2010.07.031