TY - JOUR
T1 - Association of quality of care and long-term mortality risk for individuals presenting with ST-segment myocardial infarction (STEMI) by diabetes mellitus status
T2 - A nationwide cohort study
AU - Cole, Andrew
AU - Weight, Nicholas
AU - Wijeysundera, Harindra C
AU - Rashid, Muhammad
AU - Yu, Dahai
AU - Healey, Emma L
AU - Chew, Nicholas Ws
AU - Siudak, Zbigniew
AU - Khunti, Kamlesh
AU - Kontopantelis, Evangelos
AU - Mamas, Mamas A
N1 - Copyright © 2025 The Authors. Published by Elsevier B.V. All rights reserved.
PY - 2025/4/1
Y1 - 2025/4/1
N2 - AIMS: This study aimed to assess how diabetes influences the quality of care and longer-term outcomes in contemporary STEMI cohorts.METHODS: We analysed 283,658 adults hospitalised with STEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry between 2005 and 2019. This was linked with Office of National Statistics data to provide out of hospital mortality outcomes. We compared longer-term outcomes depending on diabetes status and assessed the effect of quality of care using the opportunity-based quality-indicator score (OBQI).RESULTS: Individuals with diabetes were older (median age 68.7 vs. 65.5), underwent percutaneous coronary intervention less frequently (60 % vs. 63 %) and were less likely to achieve a door-to-balloon time of < 60 min (69 % vs. 75 %) or < 120 min (89 % vs. 92 %). Their adjusted all-cause mortality risk was higher during follow-up, from 30 days (HR: 1.49, CI: 1.44-1.54), to up to 10 years of follow up (HR: 1.54, CI: 1.52-1.57), compared to individuals without diabetes. Excellent inpatient care was associated with lower mortality rates within individuals with diabetes (Diabetes: HR 0.56, CI: 0.50-0.64, No diabetes: HR 0.62, CI: 0.58-0.67).CONCLUSIONS: Individuals with diabetes have a higher risk of long-term mortality after STEMI. They experience delays in angiography and receive lower quality inpatient care.
AB - AIMS: This study aimed to assess how diabetes influences the quality of care and longer-term outcomes in contemporary STEMI cohorts.METHODS: We analysed 283,658 adults hospitalised with STEMI from the United Kingdom Myocardial Ischaemia National Audit Project (MINAP) registry between 2005 and 2019. This was linked with Office of National Statistics data to provide out of hospital mortality outcomes. We compared longer-term outcomes depending on diabetes status and assessed the effect of quality of care using the opportunity-based quality-indicator score (OBQI).RESULTS: Individuals with diabetes were older (median age 68.7 vs. 65.5), underwent percutaneous coronary intervention less frequently (60 % vs. 63 %) and were less likely to achieve a door-to-balloon time of < 60 min (69 % vs. 75 %) or < 120 min (89 % vs. 92 %). Their adjusted all-cause mortality risk was higher during follow-up, from 30 days (HR: 1.49, CI: 1.44-1.54), to up to 10 years of follow up (HR: 1.54, CI: 1.52-1.57), compared to individuals without diabetes. Excellent inpatient care was associated with lower mortality rates within individuals with diabetes (Diabetes: HR 0.56, CI: 0.50-0.64, No diabetes: HR 0.62, CI: 0.58-0.67).CONCLUSIONS: Individuals with diabetes have a higher risk of long-term mortality after STEMI. They experience delays in angiography and receive lower quality inpatient care.
KW - Humans
KW - Male
KW - Female
KW - ST Elevation Myocardial Infarction/mortality
KW - Aged
KW - Middle Aged
KW - Quality of Health Care/statistics & numerical data
KW - Diabetes Mellitus/mortality
KW - Cohort Studies
KW - Percutaneous Coronary Intervention/statistics & numerical data
KW - United Kingdom/epidemiology
KW - Registries
KW - Risk Factors
KW - Hospital Mortality
U2 - 10.1016/j.diabres.2025.112092
DO - 10.1016/j.diabres.2025.112092
M3 - Article
C2 - 40058652
SN - 0168-8227
VL - 222
JO - Diabetes Research and Clinical Practice
JF - Diabetes Research and Clinical Practice
M1 - 112092
ER -
