Myocardial infarction (MI) subtypes may demonstrate distinct incidence patterns and risk profiles in individuals with type 1 diabetes mellitus (T1DM). A prospective multicenter cohort analysis published in The Lancet Diabetes and Endocrinology evaluated the incidence and determinants of ST-elevation myocardial infarction (STEMI) and non-ST-elevation myocardial infarction (NSTEMI) in adults with T1DM.

The FinnDiane Study included 4,215 adults with T1DM without prior MI or coronary revascularization, enrolled between November 21, 1997, and December 31, 2012. Standardized incidence rates for MI subtypes were calculated using Fine and Gray competing-risk analyses, and risk profiles were assessed using Cox regression and competing-risk models. Outcomes were verified from medical records and death certificates through 2017.

A total of 449 first-ever MI events were recorded, including 84 (19%) STEMIs and 297 (66%) NSTEMIs. The 20-year cumulative incidence was 15.4% (95% CI 12.0-19.1) for all MI, 2.4% (1.9-2.9) for STEMI, and 10.9% (7.8-14.6) for NSTEMI. Incidence increased with age, particularly for NSTEMI, with no sex differences observed. Over time, STEMI incidence declined, while NSTEMI incidence increased after an initial decrease.

Risk profiles differed between MI subtypes. Older age at diabetes onset, higher low-density lipoprotein (LDL) cholesterol, lower high-density lipoprotein (HDL) cholesterol, severe diabetic retinopathy, severe albuminuria, and kidney replacement therapy were observed more frequently with NSTEMI. Moderately and severely reduced estimated glomerular filtration rate (eGFR) was observed more frequently with STEMI. Longer diabetes duration, higher glycated hemoglobin (HbA1c), and current smoking were observed across both MI subtypes.

These findings indicate that STEMI and NSTEMI exhibit distinct incidence patterns and clinical risk profiles in individuals with T1DM, reflecting heterogeneity in myocardial infarction presentation within this population.