ARRHYTHMIAS AND MORTALITY AFTER MYOCARDIAL-INFARCTION IN DIABETIC-PATIENTS - RELATIONSHIP TO DIABETES TREATMENT

OBJECTIVE- To assess the relationship between clinical course after ac ute myocardial infarction (AMI) and diabetes treatment. RESEARCH DESIG N AND METHODS- Retrospective analysis of data from all patients aged 2 5-64 years admitted to hospitals in Perth, Australia, between 1985 and 1993 with AMI diagnosed according to the International Classification of Diseases (9th revision) criteria was conducted. Short- (28-day) an d long-term survival and complications in diabetic and nondiabetic pat ients were compared. For diabetic patients, 28-day survival, dysrhythm ias, heart block, and pulmonary edema were treated as outcomes, and fa ctors related to each were assessed using multiple logistic regression . Diabetes treatment was added to the model to assess its significance . Long-term survival was compared by means of a Cox proportional hazar ds model. RESULTS- Of 5,715 patients, 745 (12.9%) were diabetic. Morta lity at 28 days was 12.0 and 28.1% for nondiabetic and diabetic patien ts, respectively (P < 0.001); there were no significant drug effects i n the diabetic group. Ventricular fibrillation in diabetic patients ta king glibenclamide (11.8%) was similar to that of nondiabetic patients (11.0%) but was lower than that for those patients taking either glic lazide (18.0%; 0.1 > P > 0.05) or insulin (22.8%; P < 0.05). There wer e no other treatment-related differences in acute complications. Long- term survival in diabetic patients was reduced in those taking digital is and/or diuretics but type of diabetes treatment at discharge had no significant association with outcome. CONCLUSlONS- These results do n ot suggest that ischemic heart disease should influence the choice of diabetes treatment regimen in general or of sulfonylurea drug in parti cular.