Copyright © 1990 by the European Society of Cardiology.
© 1990 The European Society of Cardiology
Diabetic patients and beta-blockers after acute myocardial infarction
*Division of Cardiology, Department of Medicine, University of California, San Diego Medical Center, Veterans Administration Hospital San Diego, California, U.S.A
The Naval Hospital of San Diego San Diego, California, U.S.A
Division of Cardiology, University of British Columbia Vancouver, Canada
Received 19 July 1988; revised 19 April 1989; .
Address for correspondence: John Kjekshus, M.d., Medical Department, Baerum Hospital, Oslo, Norway
Abstract
Whether diabetic patients may benefit, compared with non-diabetic patients, from beta-blocker therapy following acute myocardial infarction was examined in a large multicentre cohort of 2024 patients, including 340 diabetics, 281 of whom survived hospitalization. One-year mortality following discharge was 17% for diabetics compared with 10% for non-diabetics (P< 0-001). However, diabetics discharged on beta-blockers had a 1-year mortality of only 10%, compared with 23% for diabetics not on beta-blockers. In non-diabetics, mortality rates were 7% and 13% for those taking and not taking beta-blockers, respectively. Bias in patient selection for beta-blocker therapy might be responsible for the trends exhibited in our population since patients were not randomized to treatment. In diabetics, evidence of pulmonary congestion on X-ray was more prevalent than in non-diabetics; this appeared to be true both for patients taking beta-blockers and for those not taking beta-blockers. However, even in diabetics without evidence of pulmonary congestion on X-ray, 1-year mortality was 7% vs 17% for those with and without beta-blocker therapy, respectively (P<0-04). In multivariate analysis, beta-blocker use was an independent predictor of 1-year cardiac survival following hospital discharge for all diabetics, even those without evidence of pulmonary congestion on X-ray, but not for non-diabetics. These data suggest a beneficial effect, but a definitive answer regarding the benefit of beta-blockade in diabetic patients after acute myocardial infarction would require a prospective, randomized study
Key Words: Acute myocardial infarction • diabetes • beta-blockers
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