1Kath. Klinikum Bochum Kardiologie und Rhytmologie Bochum, Deutschland; 2Berufsgenossenschaftliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland; 3Universitätsklinikum Mannheim I. Medizinische Klinik Mannheim, Deutschland; 4Technische Universität Dresden, Faculty of Medicine, and University Hospital Carl Gustav Carus, Department of Neurosurgery, Division of Spine Surgery Dresden, Deutschland; 5Kath. Klinikum Bochum Cellular Physiology Bochum, Deutschland; 6Klinikum der Ruhr-Universität Bochum Medizinische Klinik II, Kardiologie Bochum, Deutschland; 7Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil Medizinische Klinik II, Kardiologie und Angiologie Bochum, Deutschland
Background: Diabetes mellitus is a major cardiovascular risk factor for the development of coronary artery disease, but knowledge about the impact of diabetes mellitus on the outcome of myocardial infarction with non-obstructive coronary arteries (MINOCA) patients is limited. The aim of this study was to investigate the prognostic impact of diabetes mellitus on in- and out-of-hospital adverse events in troponin-positive patients with non-obstructive coronary arteries.
Methods and Results: A total of 373 troponin-positive patients with non-obstructive coronary arteries between 2010 and 2021 at Bergmannsheil University Hospital Bochum were enrolled, including 65 diabetics and 307 nondiabetics. The median follow-up was 6.2 years. The primary study end point was a composite of in-hospital major adverse cardiovascular events (MACE), including stroke, cardiopulmonary resuscitation, cardiogenic shock, pulmonary oedema, ventilation, left ventricular thrombus, thromboembolic events, life-threatening arrhythmias, supraventricular arrhythmias, and all-cause mortality. Secondary endpoints covered MACE during follow-up, including stroke, thromboembolic events, recurrence of troponin-positive with non-obstructive coronary arteries, percutaneous coronary intervention, cardiac arrest, and all-cause mortality.
Mean age of the study cohort was 62.9 years and 49.3% were male. Diabetics were significantly more often obese (56.9% vs. 24.1%, p<0.001), and suffered more frequently from arterial hypertension (89.2% vs. 63.7%, p<0.001), neurological diseases (35. 4% vs. 21.9%, p=0.021), chronic renal insufficiency (26.2% vs. 11.7%, p=0.003) and atrial fibrillation (26.2% vs. 13.1%, p=0.008) than non-diabetics. Although the overall rate of in-hospital MACE was higher in diabetics (41.5%) than in non-diabetics (33.9%), this difference did not reach statistical significance (p=0.240). The in-hospital mortality rate was low in both groups, 0% of diabetes group versus 2.9% of non-diabetic patients (Figure 1). During follow-up, diabetic patients had a significantly higher rate of MACE (51.9% vs. 31.1%, p=0.004) and a significantly higher all-cause mortality rate than non-diabetic patients (42.3% vs. 20.1%, p<0.001) (Figure 2).
Conclusions: Our study reveals that the impact of diabetes mellitus on cardiovascular outcomes in troponin-positive patients with non-obstructive coronary arteries intensifies over the long term, leading to increased rates of both cardiovascular adverse events and overall mortality.
Figure 1: Rate of in-hospital adverse events in diabetics and non-diabetics
Figure 2: Kaplan Meier survival analysis for out-of-hospital adverse events in diabetics versus non-diabetics