CLINICAL CHARACTERISTICS, LEFT AND RIGHT-VENTRICULAR EJECTION FRACTION, AND LONG-TERM PROGNOSIS IN PATIENTS WITH NONINSULIN-DEPENDENT DIABETES SURVIVING AN ACUTE MYOCARDIAL-INFARCTION

Patients with diabetes mellitus have a high morbidity and mortality fr om acute myocardial infarction, the reason for which is not fully unde rstood. The relationship between congestive heart failure symptoms, le ft ventricular ejection fraction, and long-term mortality was examined in 578 hospital survivors of acute myocardial infarction, 47 of whom had Type 2 (non-insulin-dependent) diabetes mellitus. None of the pati ents were treated with insulin. The prevalence of congestive heart fai lure during hospitalization was similar in patients with and without d iabetes, although mean diuretic dose was higher in the former patients . Left and right ventricular ejection fraction was measured with radio nuclide ventriculography in the second week after acute myocardial inf arction. At discharge from the coronary care unit, patients with and w ithout diabetes had similar left ventricular ejection fraction (with d iabetes: median 46% vs without diabetes: median 43%; p = 0.89). Median right ventricular ejection fraction (62%) was within normal limits in both groups and did not differ statistically. Survival data were obta ined for all patients. The 5-year mortality was increased in patients with diabetes compared with nondiabetic patients independent of left v entricular ejection fraction. Univariate analysis showed that the cumu lative 5-year mortality rate was 53% in the group with diabetes compar ed with 43% in the non-diabetic group (p = 0.007). Using multivariate regression analysis presence of diabetes was found to have a significa nt association with long-term mortality after myocardial infarction, t hat was independent of age, history of hypertension, congestive heart failure symptoms during hospitalization or of either left or right ven tricular ejection fractions at discharge. We conclude that the excess mortality in patients with non-insulin-dependent diabetes mellitus is not explained by available risk markers after myocardial infarction. E ven though left ventricular ejection fraction and serum creatinine did not differ significantly, the apparent higher dose of Frusemide in pa tients with than without non-insulin-dependent diabetes mellitus might indicate that heart failure, if present, is more severe in patients w ith than in those without diabetes. The importance of diastolic dysfun ction in this context needs to be determined.