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Title: Do differences in baseline characteristics or in management account for the poorer in-hospital and subsequent outcome after myocardial infarction in diabetics?
Subtitle: Data from a large unselected cohort
Author(s): DE GEVIGNEY, Guy , CAO, Danièle , MACFADDEN, Eugène , ECOCHARD, René , RABILLOUD, Muriel , CHENEAU, Edouard , MILON, Hugues , DELAHAYE, François
Journal: Acta Cardiologica
Volume: 57 Issue: 3 Date: June 2002
Objective— There is an excess mortality after myocardial infarction in diabetics, but also documented significant differences in the characteristics of MI and in management between diabetics and non-diabetics. The aim of this prospective study in a large unselected patient cohort in a single French region was to determine if baseline characteristics, management, or in-hospital and one-year mortality differed in diabetic and non-diabetic patients with myocardial infarction.
Methods and results— Data were prospectively collected in consecutive patients with myocardial infarction admitted to all hospitals in three departments in the Rhône-Alpes region between September 1, 1993 and January 31, 1995. Among the 2,297 patients, 410 patients (17.8%) were diabetic. Although diabetics were older than non-diabetics (70.3 vs. 67.8 years; p<0.0004), and less likely to receive thrombolysis (31% vs. 36%; p= 0.043), in-hospital mortality was not significantly higher (17.3% vs. 14.7%) than in non-diabetics. In multivariate analysis,diabetes was a significant predictor of one-year mortality (relative risk: 1.41; 95% CI = 1.10 – 1.79;p= 0.0063) but not of in-hospital mortality (relative risk: 1.2; 95% CI = 0.9 – 1.7; p= 0.25). Multivariate predictors of in-hospital and one-year mortality in diabetics were age and Killip class at admission.
Conclusions— In this large unselected French cohort, diabetes mellitus was a significant predictor of one-year but not of in-hospital mortality after myocardial infarction in a French region. This negative effect of diabetes on mortality was not related to differences in baseline characteristics, or in initial or post-discharge management between diabetics and non-diabetics.