Relationship Between Duration Of Diabetes Mellitus And Prognosis In Diabetic Patients Who Underwent Primary Percutaneous Coronary Intervention After The First Myocardial Infarction

Background: Diabetes mellitus(DM)is closely associated with increased mortality in patients with acute myocardial infarction(AMI),however,the impact of the duration of diabetes on long-term outcome of type 2 diabetic patients who underwent percutaneous coronary intervention(PCI)after the first AMI is unclear.In this study,we evaluated major adverse cardiovascular and cerebrovascular events(MACCEs)according to diabetes duration and other risk factors.Methods: A total of 404 type 2 diabetic patients who underwent PCI after their first AMI in the First Affiliated Hospital of Xinjiang Medical University from January 2010 to December 2020 were enrolled in this study and were divided into two subgroups according to their duration of diabetes: the short-DM group with diabetes duration < 5 years and the long-DM group with diabetes duration ≥ 5 years.The clinical endpoint was major adverse cardiovascular and cerebrovascular events(MACCEs),multivariate Cox regression analysis with nested Cox proportional hazard models were used to explore the influence of diabetes duration and the other related influencing factors on MACCEs and estimated hazard ratios(HR,CI95%)for the outcomes.Results: Our study population comprised 185 and 209 the short-DM patients and the long-DM patients respectively.Multivariate Cox regression analysis showed duration of diabetes was independently associated with increased MACCEs[HR 1.512,95% CI(1.033,2.215),p=0.034],along with hypertension,killip class Ⅲ or Ⅳ,creatinine,multivessel disease and continuous hypoglycemic therapy[HR0.347,95% CI(0.200,0.599),p<0.001].After adjusting for multivariables,nested Cox model showed that duration of diabetes still an independent risk factor of MACCEs[HR1.963,95%CI(1.376,2.801),p<0.001].Kaplan-Meier survival curve illustrated a significantly high risk of MACCEs(HR 2.045,p <0.0001),cardiovascular death(HR3.016,p=0.0014)in long-DM patients.Conclusion: Our study demonstrates that the long duration of diabetes was independently associated with poor clinical outcomes after PCI in diabetic patients with first myocardial infarction,Yet despite of the duration of diabetes,continuous hypoglycemic therapy can improves long-term clinical outcomes significantly.