Long-term prognosis of diabetic patients with myocardial infarction: relation to antidiabetic treatment regimen

Abstract

AimsThe present study was performed to evaluate pre-admission history, presentation, initial treatment and long-term mortality in patients with myocardial infarction and diabetes. 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 insulintreated, 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. Methods and Results ConclusionsPatients 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.

Diabetes mellitus and cardiogenic shock in acute myocardial infarction

“…However, even after correction for variables associated with an increased risk profile, including age, hypertension, heart failure, and less use of thrombolytics, the nonshock diabetics had a significantly increased mortality risk (unadjusted RR=1.9, adjusted RR=1.4) when compared to nondiabetic patients. This is in line with previous reports [9,10,12,15] and confirms that diabetics with MI should be considered a high-risk MI population.…”

Logro de metas de prevención secundaria, prescripción farmacológica y eventos cardiovasculares mayores en pacientes con enfermedad coronaria

“…A pesar que el pronóstico de los pacientes diabéticos post angioplastía, IAM y angina inestable es menos auspicioso 22,23 , en nuestro estudio no hubo diferencias en la incidencia de eventos CV mayores al compararlos con pacientes no diabé-ticos. Alrededor de 60% de los diabéticos tiene 3 o más FRCV y logran promedios de hemoglobina glicosilada < 7% en 50% de los casos, hallazgo relevante si se compara con datos de otros estudios en los cuales el promedio de hemoglobina glicosilada varía entre 7-9% [24][25][26] .…”

“…Para evaluar el logro de metas se utilizaron los objetivos establecidos por el Programa de Salud Cardiovascular implementado por el Ministerio de Salud-Chile: abandono del tabaquismo, PA < 130/85 mm Hg, colesterol total (CT) < 200 mg/ dL, triglicéridos < 150 mg/dL, colesterol HDL > 40 mg/dL, colesterol LDL < 100 mg/dL (deseable < 70 mg/dL), hemoglobina glicosilada < 7%, índice de masa corporal (IMC) normal (18,(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)9 kg/m 2 ), PC < 102 cm en hombres y < 88 cm en mujeres y prescripción de fármacos de acción CV en dosis adecuadas 14 . Los eventos CV mayores fueron: angioplastía coronaria percutánea (ACP) de urgencia o electiva, cirugía de revascularización miocárdica (CRM) electiva o de urgencia, nuevo infarto agudo al miocardio (IAM) con elevación del segmento ST, síndrome coronario agudo (SCA) sin elevación del segmento ST y accidente cerebro vascular (ACV).…”

Type of preadmission glucose-lowering treatment and prognosis among patients hospitalised with myocardial infarction: a nationwide follow-up study

“…Both sulfonylureas [3,8,9], metformin [9,10] and insulin [9,[11][12][13] have been associated with increased mortality rate compared with diet. However, this might reflect a longer duration of diabetes and thus a more advanced stage of diabetes and/or a poorer glycaemic control among users of these drugs, rather than actual drug effects.…”

“…Data regarding outcome in cardiac patients using various types of glucose-lowering drugs are sparse and conflicting [3][4][5][6][7][8][9][10][11][12][13][14], and the existing studies have some limitations, including small and often nonrepresentative samples and shortcomings in the data analysis.…”