CHARACTERISTICS, CLINICAL COURSE, AND IN-HOSPITAL MORTALITY OF NON-INSULIN-DEPENDENT DIABETIC AND NONDIABETIC PATIENTS WITH ACUTE MYOCARDIAL-INFARCTION IN ARGENTINA

The characteristics and clinical course of 1040 cases of acute myocard ial infarction (AMI) among non-insulin-dependent diabetics (146) and n ondiabetics (894) were compared. Patients with non-insulin-dependent d iabetes mellitus (NIDDM) historically showed a greater percentage of A MI, angina, and risk factors than nondiabetic patients. Although the d egree of left-ventricular function upon admission (according to the Ki llip and Kimball scores) was similar in both the diabetic and nondiabe tic groups, the prevalence of hypertension and hypercholesterolemia wa s significantly higher in the NIDDM patients. All told, NIDDM cases we re 1.73 [relative risk (RR)] times more likely to die of AMI than nond iabetic patients. The age factor and the presence of shock of any type also significantly increased the case-fatality rate. Diabetic patient s showed signs of successful reperfusion less often than control subje cts, an event that was closely associated with their case-fatality rat e. In the NIDDM group, both the age and gender factor as well as a his tory of either casual or in-hospital clinical events such as cardiogen ic shock, reinfarction, unsuccessful reperfusion, and incidence of ant erior AMI along with either pain or previous angina were clear prognos ticators of poor outcome from AMI. In the nondiabetic group, cardiogen ic shock and hypertension were indicators of poor prognosis. These res ults would suggest that an improvement in the incidence of successful reperfusion in NIDDM patients, particularly in the face of clinical in dicators of poor AMI prognosis, could decrease the high AMI mortality currently observed in these patients. (C) Elsevier Science Inc., 1997.