THE RELATION OF DIABETES TO THE SEVERITY OF ACUTE MYOCARDIAL-INFARCTION AND POSTMYOCARDIAL INFARCTION SURVIVAL IN MEXICAN-AMERICANS AND NON-HISPANIC WHITES - THE CORPUS-CHRISTI HEART PROJECT

The effect of diabetes on survival after myocardial infarction (MI) wa s examined in a prospective population-based study of individuals hosp italized with MI in a bi-ethnic community of Mexican-Americans and non -Hispanic whites. Among Mexican-Americans, 54% (331 of 610) had diabet es compared with 33% (192 of 589) of non-Hispanic whites (P < 0.001). Among those with diabetes, the prevalence of a history of a cardiac ev ent before the index admission was significantly higher (odds ratio = 1.4, 95% confidence interval [CI] 1.1-1.8) than among nondiabetic subj ects. During the index hospitalization, diabetic subjects received car diac catherization less frequently than did nondiabetic subjects (45.1 vs. 51.5%, P = 0.03). Diabetic subjects had lower estimated ejection fractions, and the number of coronary arteries with significant obstru ction (> 75%) was higher (P < 0.001). The peak creatine phosphokinase and creatine phosphokinase myocardial isoenzyme (CK-MB) levels were si milar in diabetic and nondiabetic subjects. Despite a similar infarct size, diabetic subjects had a higher incidence of congestive heart fai lure (relative ratio = 2.2, 95% CI 1.7-2.8), more adverse indexes of s hort-term and long-term prognosis, and a longer average hospital stay (12.1 vs. 8.9 days, P < 0.01). After adjustment for age, sex, and ethn icity, the cumulative risk for total mortality, over 44 months of foll ow-up, was 37.4% among diabetic compared with 23.3% among nondiabetic subjects (P < 0.001). Diabetic subjects had a higher 28-day case-fatal ity rate post-MI as well as higher long-term mortality. In conclusion, diabetic subjects have similar size infarcts compared with nondiabeti c subjects, but they have a more complicated hospital course and highe r total mortality post-MI. Diabetes had a similar adverse effect on po st-MI mortality in both Mexican-Americans and non-Hispanic whites.