Role of Diabetes Mellitus in Acute Coronary Syndrome Patients with Heart Failure With Mid-Range Ejection Fraction Underwent Percutaneous Coronary Intervention: A 3-Year Case Series Follow-Up Retrospective Study

Abstract Backgroud Data are limited about the effect of diabetes mellitus (DM) on prognosis of acute coronary syndrome (ACS) patients with heart failure with mid-range ejection fraction (HFmrEF) underwent percutaneous coronary intervention (PCI). This study aimed to investigate the relationship between type 2 diabetes mellitus(T2DM) and the 3-year outcomes in such population.Methods 377 ACS patients with HFmrEF (left ventricular EF 40–49%) underwent PCI (132 diabetic and 245 nondiabetic patients) were included into analysis. The primary outcome was a composite endpoint of all-cause death or HF rehospitalization. Cox proportional-hazards regression analysis and Kaplan–Meier test were used to assess the effect of diabetes on the primary outcome. Sensitivity analysis was conducted with propensity score-matching analysis.Results During a follow-up of three years, diabetic patients had a higher incidence rate of the primary outcome than nondiabetic patients (96.1 vs. 44.6 per 1000 patient-years, incidence rate ratio 2.301, 95% confidence interval 1.334–3.969; P=0.002). Multivariate analysis showed that diabetes mellitus was associated with a significant increase in the composite outcome of all-cause death or HF rehospitalization (adjusted hazard ratio 2.080, 95% confidence interval 1.115–3.878, P=0.021). Sensitivity analysis further confirmed that diabetes mellitus was an independent prognostic factor of long-term adverse outcome for ACS patients with HFmrHF who underwent PCI (adjusted hazard ratio 3.792, 95% confidence interval 1.802-7.980, P＜0.001).Conclusions Among ACS patients with HFmrEF underwent PCI, complicating with T2DM was significantly associated with worse long-term outcomes.