Diabetes mellitus is a strong negative prognostic factor in patients with myocardial infarction treated with thrombolytic therapy

Objectives. To assess the long-term prognostic values of baseline demograph ic data, occurrence of vectorcardiographic signs of reperfusion, left ventr icular function and coronary angiographic features. Design. Longitudinal study of morbidity and mortality. Setting. Coronary care unit at Danderyd Hospital, Stockholm, Sweden. Subjects. A total of 222 patients (mean age 61 years) with a suspected acut e myocardial infarction treated with thrombolysis were investigated and fol lowed for 2-5 years (mean 1216 days). Main outcome measures. Death or a new myocardial infarction. Results. Age above 55 years (P < 0.05), a previous diagnosis of diabetes me llitus (P < 0.005), hypertension (P < 0.05), heart failure (P < 0.001) and myocardial infarction (P < 0.05), a previous use of beta-blockers (P < 0.05 ) and an ejection fraction below 60% (P < 0.01) were predictors for death o r a new myocardial infarct ion in univariate analysis. Sex, a previous hist ory of smoking or angina pectoris, vectorcardiographic signs of reperfusion or degree of coronary artery disease had no prognostic values. In multivar iate analysis including age above 55 years, a previous diagnosis of diabete s mellitus, hypertension and myocardial infarction, and an ejection fractio n below 60%, only age (P < 0.05), diabetes mellitus (P < 0.01) and ejection fraction (P < 0.05) were predictors for death or a new myocardial infarcti on. Conclusions. The results of the present study emphasize the importance of d iabetes mellitus as a long-term prognostic risk factor in patients with myo cardial infarction treated with thrombolysis. Further studies are needed to determine the mechanisms behind this increased risk.