Clinical Outcomes and Racial Disparities in NSTEMI Patients with Concomitant Diabetic Ketoacidosis: A National Inpatient Analysis

Background

Diabetic ketoacidosis (DKA) may complicate acute cardiovascular events, including Non-ST Elevation Myocardial Infarction (NSTEMI). This study evaluated whether a secondary diagnosis of DKA affects clinical outcomes in hospitalized NSTEMI patients.

Methods

We conducted a retrospective cohort analysis using the National Inpatient Sample (2016–2020). Multivariate logistic regression adjusted for comorbidities to assess the impact of DKA on outcomes. Primary endpoints were in-hospital mortality, length of stay and total hospital charge; secondary outcomes included cardiogenic shock, acute heart failure, and cardiac arrest.

Results

Among 2,141,719 NSTEMI patients, 942,474 had a secondary diagnosis of DKA. Compared to those without DKA, these patients had lower adjusted odds of mortality (AOR 0.69; 95% CI, 0.66–0.72; p < 0.001) and shorter hospital stays (−0.35 days; p < 0.001). They were more likely to receive left heart catheterization (AOR 1.35) and early intervention. Odds of cardiac arrest (AOR 0.83), cardiogenic shock (AOR 0.87), and acute heart failure (AOR 0.75) were also lower, despite higher hospitalization costs (+$3,573; p < 0.001).

Racial disparities were also evident in this study. Asian patients had higher mortality than White patients (AOR 1.29; 95% CI, 1.15–1.44; p < 0.001) while Non-Hispanic Black patients had lower mortality (AOR 0.89; 95% CI, 0.83–0.95; p = 0.001). Minoritized groups also had lower rates of left heart catheterization and early intervention.

Conclusion

Contrary to expectations, NSTEMI patients with DKA had lower mortality and fewer complications, possibly due to timely intervention and metabolic optimization. Racial disparities in outcomes and procedure use highlight the need for equitable access to cardiovascular care.