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

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

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Sudden Cardiac Death
Type 2 Diabetes Mellitus
Myocardial Infarction
Incidence
Stroke Volume
Atherosclerosis
Confidence Intervals
Mortality

Keywords

  • Diabetes Mellitus
  • Myocardial infarction
  • Prognosis
  • Sudden deat

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Junttila, M. J., Barthel, P., Myerburg, R. J., Mäkikallio, T. H., Bauer, A., Ulm, K., ... 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

Sudden cardiac death after myocardial infarction in patients with type 2 diabetes. / Junttila, M. Juhani; Barthel, Petra; Myerburg, Robert J; Mäkikallio, Timo H.; Bauer, Axel; Ulm, Kurt; Kiviniemi, Antti; Tulppo, Mikko; Perkiömki, Juha S.; Schmidt, Georg; Huikuri, Heikki V.

In: Heart Rhythm, Vol. 7, No. 10, 01.10.2010, p. 1396-1403.

Research output: Contribution to journalArticle

Junttila, MJ, Barthel, P, Myerburg, RJ, Mäkikallio, TH, Bauer, A, Ulm, K, Kiviniemi, A, Tulppo, M, Perkiömki, JS, Schmidt, G & Huikuri, HV 2010, 'Sudden cardiac death after myocardial infarction in patients with type 2 diabetes', Heart Rhythm, vol. 7, no. 10, pp. 1396-1403. https://doi.org/10.1016/j.hrthm.2010.07.031
Junttila, M. Juhani ; Barthel, Petra ; Myerburg, Robert J ; Mäkikallio, Timo H. ; Bauer, Axel ; Ulm, Kurt ; Kiviniemi, Antti ; Tulppo, Mikko ; Perkiömki, Juha S. ; Schmidt, Georg ; Huikuri, Heikki V. / Sudden cardiac death after myocardial infarction in patients with type 2 diabetes. In: Heart Rhythm. 2010 ; Vol. 7, No. 10. pp. 1396-1403.
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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{\%}.",
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AU - Barthel, Petra

AU - Myerburg, Robert J

AU - Mäkikallio, Timo H.

AU - Bauer, Axel

AU - Ulm, Kurt

AU - Kiviniemi, Antti

AU - Tulppo, Mikko

AU - Perkiömki, Juha S.

AU - Schmidt, Georg

AU - Huikuri, Heikki V.

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N2 - 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%.

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KW - Diabetes Mellitus

KW - Myocardial infarction

KW - Prognosis

KW - Sudden deat

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