Sudden Cardiac Death After Myocardial Infarction in Patients With Type 2 Diabetes

Heart Rhythm. 2010 Oct;7(10):1396-403. doi: 10.1016/j.hrthm.2010.07.031. Epub 2010 Aug 1.

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] 2.4-5.8; P <.001) and adjusted HR of 2.3 (95% CI 1.4-3.8; 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%.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Death, Sudden / etiology
  • Death, Sudden, Cardiac / etiology*
  • Diabetes Mellitus, Type 2 / complications*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Myocardial Infarction / complications*
  • Myocardial Infarction / mortality
  • Risk Factors