Objective:

To investigate the prognostic significance of admission ALI for long-term mortality in patients with acute myocardial infarction (AMI) and concomitant diabetes.

Approach:

• Study Design: Retrospective observational study using data from the NOAFCAMI-SH registry, involving 571 diabetic AMI patients.
• Data Analysis: Patients were stratified into ALI tertiles and outcomes assessed using Kaplan-Meier survival curves, Cox proportional hazards regression, and restricted cubic spline models.

Key Findings:

• Patients in the highest ALI tertile (T3) had significantly lower rates of all-cause mortality (7.9% vs. 27.8%) and cardiovascular mortality (7.4% vs. 23.6%) compared to the lowest tertile (T1).
• Higher ALI (T3 vs. T1) was associated with a 67% reduction in the risk of all-cause mortality (HR = 0.33, 95% CI: 0.18–0.61, P < 0.001) and a similar significant decrease in cardiovascular mortality.
• RCS analysis indicated a significant non-linear relationship between continuous ALI and mortality outcomes, with increased risk below a specific threshold.
• Adding ALI to the GRACE score improved individual-level risk reclassification and discrimination for all-cause mortality.

Interpretation:

A lower admission ALI is associated with long-term all-cause and cardiovascular mortality in diabetic AMI patients.

Limitations:

• The study is retrospective and may be subject to selection bias.
• Data was collected from a single center, which may limit generalizability.

Conclusion:

ALI serves as a readily accessible composite biomarker that provides valuable prognostic information for risk stratification in diabetic AMI patients.