ACUTE MYOCARDIAL-INFARCTION IN DIABETIC-PATIENTS IN THE THROMBOLYTIC ERA

To examine the benefits of thrombolytic therapy in diabetic patients w ith acute myocardial infarction a retrospective study of all diabetic and non-diabetic patients with acute myocardial infarction admitted to the coronary care unit of the General Hospital, Birmingham between Ja nuary 1984 and December 1987 was made and findings compared to corresp onding groups admitted between January 1990 and May 1992 when thrombol ytic therapy was routine. In-hospital mortality and morbidity were ass essed in 208 diabetic and 1029 non-diabetic patients with acute myocar dial infraction admitted between 1984 and 1987 and in 115 diabetic and 501 non-diabetic patients admitted with myocardial infarction between January 1990 and May 1992. Following the introduction of thrombolytic therapy, there was a reduction in mortality among non-diabetic patien ts from 17 % to 8.5 %; p < 0.001 (observed reduction: 49 %; 95 % Cl: 3 0-70 %) and in the incidence of left ventricular failure (from 22 % to 8 %, p < 0.01 (observed reduction: 52 %; 95 % Cl: 40-85.5 %). Diabeti c patients showed a reduction in mortality from 30 % to 17 %; p = 0.02 (observed reduction: 42 %; 95 % Cl: 9.4-73.8 %) and in the incidence of left ventricular failure from 39 % to 21 %; p < 0.01 (observed redu ction: 45 %; 95 % Cl: 20.3-72.5 %). Thrombolytic therapy confers a maj or benefit on diabetic patients with acute myocardial infarction, alth ough this group remains at a prognostic disadvantage compared to non-d iabetic patients.