RATE AND MODE OF DEATH DURING 5 YEARS OF FOLLOW-UP AMONG PATIENTS WITH ACUTE CHEST PAIN WITH AND WITHOUT A HISTORY OF DIABETES-MELLITUS

In order to determine the effect of diabetes on the mortality rate and mode of death during 5 years of follow-up among patients who came to the emergency department with acute chest pain or other symptoms sugge stive of acute myocardial infarction (AMI), all patients thus presenti ng to one single hospital during a period of 22 months were followed f or 5 years. In total 5230 patients were included, of whom 402 (8 %) ha d a history of diabetes. Patients with diabetes differed from those wi thout by being older, having a higher prevalence of previously diagnos ed cardiovascular diseases, having less symptoms of chest pain and mor e symptoms of acute severe heart failure, and more electrocardiographi c (ECG) abnormalities on admission. Diabetic patients had a 5-year mor tality of 53.5 % as compared with 23.3 % among non-diabetic patients ( p < 0.001; adjusted risk ratio 1.60; 95 % confidence limits 1.35-1.90) . Among diabetic patients the following appeared as independent predic tors of death: age (p < 0.001), ST-segment elevation on admission (P < 0.001), a history of myocardial infarction (p < 0.05), and a non-path ological ECG on admission (p < 0.001). We conclude that among diabetic patients admitted to the emergency department with acute chest pain o r other symptoms suggestive of AMI more than 50 % are dead 5 years lat er. Future research should focus on interventions in order to reduce t heir mortality. (C) 1998 John Wiley & Sons, Ltd.