Age-related difference in the

impact of diabetes mellitus on

all-cause mortality after acute
myocardial infarction
Pil SangSong1; Hyeon-CheolGwon2; Myung Ho Jeong3; Jin-Ok Jeong1; KAMIR-NIH Investigators

1Division of Cardiology, Department of Internal Medicine, Chungnam National University Hospital,

Chungnam National University College of Medicine, Daejeon, Republic of Korea
2Division of Cardiology, Department of Medicine,
Heart Vascular Stroke Institute, Samsung Medical Center,
Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
3Chonnam National University Hospital, Gwangju, Republic of Korea
Disclosures
• The authors declare that we have no competing interests.
INTRODUCTION
• Given the paucity of data on the frequency and prognostic
implications of diabetes among those who experienced an
AMI at a young age, we sought to determine the prevalence
of diabetes and associated clinical outcomes in a more
contemporary cohort of patients presenting with AMI at age
≤ 55 years (young).
INTRODUCTION
• In addition, few studies have investigated age-related
differences in the long-term outcomes of diabetic versus
non-diabetic patients with AMI.
• Therefore, this study also aimed to compare the baseline
characteristics and clinical outcomes of diabetic and non-
diabetic patients with AMI by age.
METHODS
• A total of 12,600 AMI patients from the Korea Acute Myocardial
Infarction Registry-National Institute of Health (KAMIR-NIH)
between November 2011 and December 2015 was classified into
young (n = 3,590 [29%]) and old (n = 9,010 [72%]).
• Those less than 55 years of age were considered young.
• We performed comparisons of baseline characteristics, in-hospital
treatments, and 3-year clinical outcomes between patients with and
without diabetes after stratification according to age group.
Patients Flow
RESULTS
Newly Diagnosed
Diabetics
(n = 270; 28.3%)

Diabetics
(n = 953; 26.5%)
• The prevalence of diabetes
mellitus was 27% in the young Young AMI Group
AMI group. (n = 3,590; 28.5%)
RESULTS
• In the multivariable adjusted model of the entire cohort,
diabetes mellitus was associated strongly with 3-year all-
cause mortality (13% vs. 6.8%; adjusted hazard ratio [HR],
1.318; 95% confidence interval [CI], 1.138–1.526; P<0.001)
(Table 1).
Table 1. Relationship between diabetes and
clinical outcomes after acute myocardial
infarction in the entire cohort.
Diabetes Non-diabetes Adjusted HR (95% CI) for P Value
(n = 4294) (n = 8306) Diabetes
All-Cause Mortality 539 (12.6) 566 (6.8) 1.32 (1.14–1.53) < 0.001
Cardiac Mortality 284 (6.6) 283 (3.4) 1.29 (1.05–1.59) 0.016
re-MI 219 (5.1) 247 (3.0) 1.38 (1.13–1.69) 0.002
re-HHF 251 (5.8) 260 (3.1) 1.20 (0.98–1.47) 0.076
MACE 851 (19.8) 965 (11.6) 1.17 (1.05–1.31) 0.005

MACE (Major Adverse Cardiac Events) = a composite of all-cause mortality, recurrent myocardial infarction (re-MI),
and re-hospitalization for heart failure (re-HHF) at 3 years.
CI = confidence interval, HR = hazard ratio.
RESULTS
• When the entire cohort was subdivided into two age groups,
young diabetic patients showed a 107% higher mortality
rate than those without diabetes (adjusted HR, 2.07 [1.15–
3.72]; P = 0.015).
• Meanwhile, old diabetic patients had a 25% higher risk of
mortality than non-diabetic patients (adjusted HR, 1.25
[1.08–1.46]; P = 0.004) (Figure 1).
• The interaction of diabetes with age was significant
(adjusted P for interaction = 0.008) (Table 2).
Figure 1. Cumulative Incidence of All-Cause
Mortality

(A) in theYoung Age Group, and (B) in the Old Age Group., CI = confidence interval, HR = hazard ratio
Table 2. Relationship between diabetes and
clinical outcomes after acute myocardial
infarction for two age categories.
CONCLUSIONS
• Diabetes mellitus is not uncommon in younger AMI patients,
and the relative risk of 3-year mortality is significantly higher
in young patients than in older counterparts.
• More aggressive treatments are needed to prevent future
cardiovascular events in younger patients after AMI.