Suzanne V Arnold1, John A Spertus2, Philip G Jones2, Darren K McGuire2, Kasia J Lipska2, Yaping Xu2, Joshua M Stolker2, Abhinav Goyal2, Mikhail Kosiborod2. 1. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., P.G.J., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Yale University School of Medicine, New Haven, CT (K.J.L.); Genentech, South San Francisco, CA (Y.X.); Saint Louis University, St. Louis, MO (J.M.S.); and Emory School of Medicine, Atlanta, GA (A.G.). suz.v.arnold@gmail.com. 2. From the Saint Luke's Mid America Heart Institute, Kansas City, MO (S.V.A., J.A.S., P.G.J., M.K.); University of Missouri-Kansas City (S.V.A., J.A.S., M.K.); University of Texas Southwestern Medical Center, Dallas (D.K.M.); Yale University School of Medicine, New Haven, CT (K.J.L.); Genentech, South San Francisco, CA (Y.X.); Saint Louis University, St. Louis, MO (J.M.S.); and Emory School of Medicine, Atlanta, GA (A.G.).
Abstract
BACKGROUND: Although patients with diabetes mellitus experience high rates of adverse events after acute myocardial infarction (AMI), including death and recurrent ischemia, some diabetic patients are likely at low risk, whereas others are at high risk. We sought to develop prediction models to stratify risk after AMI in patients with diabetes mellitus. METHODS AND RESULTS: We developed prediction models for long-term mortality and angina among 1613 patients with diabetes mellitus discharged alive after AMI from 24 US hospitals and then validated the models in a separate, multicenter registry of 786 patients with diabetes mellitus. Event rates in the derivation cohort were 27% for 5-year mortality and 27% for 1-year angina. Parsimonious prediction models demonstrated good discrimination (c-indices=0.78 and 0.69, respectively) and excellent calibration. Within the context of the predictors we estimated, the strongest predictors for mortality were higher creatinine, not working at the time of the AMI, older age, lower hemoglobin, left ventricular dysfunction, and chronic heart failure. The strongest predictors for angina were angina burden in the 4 weeks before the AMI, younger age, history of prior coronary bypass graft surgery, and non-white race. The lowest and highest deciles of predicted risk ranged from 4% to 80% for mortality and 12% to 59% for angina. The models also performed well in external validation (c-indices=0.78 and 0.73, respectively). CONCLUSIONS: We found a wide range of risk for adverse outcomes after AMI in diabetic patients. Predictive models can identify patients with diabetes mellitus for whom closer follow-up and aggressive secondary prevention strategies should be considered.
BACKGROUND: Although patients with diabetes mellitus experience high rates of adverse events after acute myocardial infarction (AMI), including death and recurrent ischemia, some diabeticpatients are likely at low risk, whereas others are at high risk. We sought to develop prediction models to stratify risk after AMI in patients with diabetes mellitus. METHODS AND RESULTS: We developed prediction models for long-term mortality and angina among 1613 patients with diabetes mellitus discharged alive after AMI from 24 US hospitals and then validated the models in a separate, multicenter registry of 786 patients with diabetes mellitus. Event rates in the derivation cohort were 27% for 5-year mortality and 27% for 1-year angina. Parsimonious prediction models demonstrated good discrimination (c-indices=0.78 and 0.69, respectively) and excellent calibration. Within the context of the predictors we estimated, the strongest predictors for mortality were higher creatinine, not working at the time of the AMI, older age, lower hemoglobin, left ventricular dysfunction, and chronic heart failure. The strongest predictors for angina were angina burden in the 4 weeks before the AMI, younger age, history of prior coronary bypass graft surgery, and non-white race. The lowest and highest deciles of predicted risk ranged from 4% to 80% for mortality and 12% to 59% for angina. The models also performed well in external validation (c-indices=0.78 and 0.73, respectively). CONCLUSIONS: We found a wide range of risk for adverse outcomes after AMI in diabeticpatients. Predictive models can identify patients with diabetes mellitus for whom closer follow-up and aggressive secondary prevention strategies should be considered.
Authors: John A Spertus; Adam C Salisbury; Philip G Jones; Darcy Green Conaway; Randall C Thompson Journal: Circulation Date: 2004-12-13 Impact factor: 29.690
Authors: Joseph Vaglio; David M Safley; Mohamed Rahman; Mikhail Kosiborod; Philip Jones; Randall Thompson; Harlan M Krumholz; John A Spertus Journal: Am J Cardiol Date: 2005-08-15 Impact factor: 2.778
Authors: John A Spertus; Eric Peterson; John S Rumsfeld; Philip G Jones; Carole Decker; Harlan Krumholz Journal: Am Heart J Date: 2006-03 Impact factor: 4.749
Authors: Keith A A Fox; Omar H Dabbous; Robert J Goldberg; Karen S Pieper; Kim A Eagle; Frans Van de Werf; Alvaro Avezum; Shaun G Goodman; Marcus D Flather; Frederick A Anderson; Christopher B Granger Journal: BMJ Date: 2006-10-10
Authors: Harlan M Krumholz; Yun Wang; Jersey Chen; Elizabeth E Drye; John A Spertus; Joseph S Ross; Jeptha P Curtis; Brahmajee K Nallamothu; Judith H Lichtman; Edward P Havranek; Frederick A Masoudi; Martha J Radford; Lein F Han; Michael T Rapp; Barry M Straube; Sharon-Lise T Normand Journal: JAMA Date: 2009-08-19 Impact factor: 56.272
Authors: Thomas M Maddox; Kimberly J Reid; John A Spertus; Murray Mittleman; Harlan M Krumholz; Susmita Parashar; P Michael Ho; John S Rumsfeld Journal: Arch Intern Med Date: 2008-06-23
Authors: Kim A Eagle; Michael J Lim; Omar H Dabbous; Karen S Pieper; Robert J Goldberg; Frans Van de Werf; Shaun G Goodman; Christopher B Granger; P Gabriel Steg; Joel M Gore; Andrzej Budaj; Alvaro Avezum; Marcus D Flather; Keith A A Fox Journal: JAMA Date: 2004-06-09 Impact factor: 56.272
Authors: Sean M Donahoe; Garrick C Stewart; Carolyn H McCabe; Satishkumar Mohanavelu; Sabina A Murphy; Christopher P Cannon; Elliott M Antman Journal: JAMA Date: 2007-08-15 Impact factor: 56.272
Authors: Zubair Akhtar; Mohammad Abdul Aleem; Probir Kumar Ghosh; A K M Monwarul Islam; Fahmida Chowdhury; C Raina MacIntyre; Ole Fröbert Journal: BMC Cardiovasc Disord Date: 2021-02-10 Impact factor: 2.298
Authors: Anne M Kerola; Markus Juonala; Antti Palomäki; Anne Grete Semb; Päivi Rautava; Ville Kytö Journal: Diabetes Care Date: 2022-07-07 Impact factor: 17.152