European Heart Journal Advance Access originally published online on February 8, 2007
European Heart Journal 2007 28(5):540-545; doi:10.1093/eurheartj/ehl510
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Temporal trends in mortality of patients with diabetes mellitus suffering acute myocardial infarction: a comparison of over 3000 patients between 1995 and 2003
1 Leeds Institute of Genetics, Health, and Therapeutics, The LIGHT Laboratories, Clarendon Way, Leeds LS2 9JT, UK
2 BHF Heart Research Centre, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
3 Department of Chemical Pathology and Metabolic Medicine, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, UK
4 Department of Cardiology, St James' University Hospital, Beckett Street, Leeds LS9 7TF, UK
Received 10 October 2006; revised 9 December 2006; accepted 12 January 2007; online publish-ahead-of-print 8 February 2007.
* Corresponding author. Tel: +44 1133437764; fax: +44 1133437738. E-mail address: m.t.kearney{at}leeds.ac.uk
Aims: Over the last decade, advances in treatment for patients sustaining an acute myocardial infarction (AMI) have reduced mortality rates. We aimed to assess whether patients with diabetes mellitus (DM) have derived similar benefits as patients without DM.
Methods and results: We compared characteristics, management, and survival of patients with and without DM who sustained an AMI in 1995 (n = 1762) with a second group of patients who sustained an AMI in 2003 (n = 1642). All patients were followed up for 18 months or until death. Between 1995 and 2003 the prevalence of DM in AMI patients increased from 12.5 to 16.6% (P < 0.001). Involvement of cardiologists, provision of secondary prevention agents and early revascularization rates improved in both groups. Thirty-day mortality improved significantly in patients with and without DM [40% (P = 0.006) and 30% (P < 0.001) relative reductions, respectively]. Despite this, there was no significant change in mortality at 18 months in patients with DM when comparing 1995 and 2003 (absolute mortality 38.0 vs. 36.4%, P = 0.71). The interaction between DM and study period in predicting long-term mortality was highly significant (P = 0.008); this persisted after adjustment for baseline characteristics and treatment variables.
Conclusion: Although early post-AMI mortality has fallen in patients with and without DM, these improvements were only maintained in the longer term in those without DM; more effective diabetes-related management strategies are required post-AMI.
Key Words: Diabetes mellitus • Acute myocardial infarction • Temporal trends
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