Rate and mode of death during five years of follow-up among patients with acute chest pain with and without a history of diabetes mellitus

Abstract

In order to determine the effect of diabetes on the mortality rate and mode of death during 5 years of follow-up among patients who came to the emergency department with acute chest pain or other symptoms suggestive of acute myocardial infarction (AMI), all patients thus presenting to one single hospital during a period of 21 months were followed for 5 years. In total 5230 patients were included, of whom 402 (8%) had a history of diabetes. Patients with diabetes differed from those without by being older, having a higher prevalence of previously diagnosed cardiovascular diseases, having less symptoms of chest pain and more symptoms of acute severe heart failure, and more electrocardiographic (ECG) abnormalities on admission. Diabetic patients had a 5-year mortality of 53.5% as compared with 23.3% among non-diabetic patients (p < 0.001; adjusted risk ratio 1.60; 95% confidence limits 1.35-1.90). Among diabetic patients the following appeared as independent predictors of death: age (p < 0.001), ST-segment elevation on admission (P < 0.001), a history of myocardial infarction (p < 0.05), and a non-pathological ECG on admission (p < 0.001). We conclude that among diabetic patients admitted to the emergency department with acute chest pain or other symptoms suggestive of AMI more than 50% are dead 5 years later. Future research should focus on interventions in order to reduce their mortality.

Diabetes and Vascular Disease

“…13 Approximately 50% of diabetic patients die 5 years after a myocardial infarction, double the rate found in nondiabetic patients. 14 …”

Comparison of atherosclerotic plaque burden and composition between diabetic and non diabetic patients by non invasive CT angiography

“…Type 2 DM is also associated with a worse prognosis in patients with coronary artery disease (CAD) with double the mortality rate after myocardial infarction when compared with non-diabetic patients [2]. Atherosclerotic plaque composition rather than plaque size or degree of coronary artery stenosis has been shown to be an important determinant of the evolution and disruption of plaque [3,4].…”

Preventing cardiovascular disease in diabetes

“…1,2 Moreover, diabetes worsens outcomes in acute coronary syndromes, with a five-year mortality of at least 50%. 3 Thus, people with type 2 diabetes are prime candidates for primary or secondary prevention. The growing prevalence of diagnosed type 2 diabetes makes it an ever increasing cause of cardiovascular morbidity and mortality, particularly in ethnic groups where diabetes is more common (eg Indo-Asian and Black people).…”

“…Up to 10% of UK hospital inpatients 2 and six million people hospitalised each year in the USA are diabetic. 3 Patient associations identify hospitalisation as a priority time in diabetic life for better care because poor glycaemic control increases susceptibility to complications and lengthens hospital stay. 4 It is also an unhappy time if, as too often happens, patients who are experts in self-care are denied information, support and autonomy.…”