Impact of diabetes on long-term prognosis in patients with unstable anginaand non-Q-wave myocardial infarction - Results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) registry

Background-Although unstable coronary artery disease is the most common rea son for admission to a coronary care unit, the long-term prognosis of patie nts with this diagnosis is unknown. This is particularly true for patients with diabetes mellitus, who are known to have a high morbidity and mortalit y after an acute myocardial infarction. Methods and Results-Prospectively collected data from 6 different countries in the Organization to Assess Strategies for Ischemic Syndromes (OASIS) re gistry were analyzed to determine the 2-year prognosis of diabetic and nond iabetic patients who were hospitalized with unstable angina or non-Q-wave m yocardial infarction. Overall, 1718 of 8013 registry patients (21%) had dia betes. Diabetic patients had a higher rate of coronary bypass surgery than nondiabetic patients (23% versus 20%, P<0.001) but had similar rates of cat heterization and angioplasty. Diabetes independently predicted mortality (r elative risk [RR], 1.57; 95% CI, 1.38 to 1.81; P<0.001), as well as cardiov ascular death, new myocardial infarction, stroke, and new congestive heart failure. Moreover, compared with their nondiabetic counterparts, women had a significantly higher risk than men (RR, 1.98; 95% CI, 1.60 to 2.44; and R R, 1.38; 95% CI, 1.06 to 1.56, respectively). Interestingly, diabetic patie nts without prior cardiovascular disease had the same event rates for all o utcomes as nondiabetic patients with previous vascular disease. Conclusions-Hospitalization for unstable angina or non-Q-wave myocardial in farction predicts a high 2-year morbidity and mortality; this is especially evident for patients with diabetes. Diabetic patients with no previous car diovascular disease have the same long-term morbidity and mortality as nond iabetic patients with established cardiovascular disease after hospitalizat ion for unstable coronary artery disease.