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European Heart Journal 2000 21(23):1937-1943; doi:10.1053/euhj.2000.2244
Copyright © 2000 by the European Society of Cardiology.
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Long-term prognosis of diabetic patients with myocardial infarction: relation to antidiabetic treatment regimen

I Gustafssona,f1, P Hildebrandta, M Seibækb, T Melchiorb, C Torp-Pedersenb, L Køberb and P Kaiser-Nielsenc

a Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Copenhagen, Denmark
b Department of Cardiology, Gentofte University Hospital, Copenhagen, Denmark
c Department of Internal Medicine, Hørsholm Hospital, Hørsholm, Denmark

Received April 11, 2000; accepted April 12, 2000

Abstract

Aims The present study was performed to evaluate pre-admission history, presentation, initial treatment and long-term mortality in patients with myocardial infarction and diabetes.

Methods and Results Between 1990 and 1992, 6676 patients with acute myocardial infarction were screened for entry into the Trandolapril Cardiac Evaluation (TRACE) study. In this cohort 719 (11%) of the patients had a history of diabetes. Among the diabetic patients 19% were treated with insulin, 52% with oral hypoglycaemic agents and 29% with diet only. The diabetic patients were slightly older, more likely to be female and had a higher prevalence of known cardiovascular disease. Even though the diabetic patients had the same frequency of ST-segment elevation on the electrocardiogram and the same admission delay, treatment with thrombolysis and aspirin was less frequently prescribed to the diabetic patients than to patients without diabetes. The mortality rate was significantly increased in the diabetic patients, 7-year mortality being 79% in insulin-treated, 73% in tablet-treated and 62% in diet-treated diabetic patients compared with 46% in patients without diabetes. In a multivariate analysis only diabetic patients treated with oral hypoglycaemic agents or with insulin had an increased mortality compared with non-diabetic patients.

Conclusions Patients with diabetes mellitus and myocardial infarction are treated with thrombolysis to a lesser extent than non-diabetic patients. Diabetic patients treated with oral hypoglycaemic agents or insulin, but not those treated with diet alone, have a significantly increased mortality following acute myocardial infarction compared with non-diabetic patients.

Key Words: Myocardial infarction, left ventricular function, mortality, thrombolysis, diabetes mellitus, oral hypoglycaemic agents

f1 Correspondence: Ida Gustafsson, MD, Department of Cardiology and Endocrinology, Frederiksberg University Hospital, Nordre Fasanvej 57, DK-2000 Frederiksberg, Denmark.

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