Long-term prognosis of diabetic patients with myocardial infarction: relation to antidiabetic treatment regimen

Aims The present study was performed to evaluate pre-admission history, pre sentation, initial treatment and long-term mortality in patients with myoca rdial infarction and diabetes. Methods and Results Between 1990 and 1992, 6676 patients with acute myocard ial infarction were screened for entry into the Trandolapril Cardiac Evalua tion (TRACE) study. In this cohort 719 (11%) of the patients had a history of diabetes. Among the diabetic patients 19% were treated with insulin, 52% with oral hypoglycaemic agents and 29% with diet only. The diabetic patien ts were slightly older, more likely to be female and had a higher prevalenc e of known cardiovascular disease. Even though the diabetic patients had th e same frequency of ST-segment elevation on the electrocardiogram and the s ame admission delay, treatment with thrombolysis and aspirin was less frequ ently prescribed to the diabetic patients than to patients without diabetes . The mortality rate was significantly increased in the diabetic patients, 7-year mortality being 79% in insulin-treated, 73% in tablet-treated and 62 % in diet-treated diabetic patients compared with 46% in patients without d iabetes. In a multivariate analysis only diabetic patients treated with ora l hypoglycaemic agents or with insulin had an increased mortality compared with non-diabetic patients. Conclusions Patients with diabetes mellitus and myocardial infarction are t reated with thrombolysis to a lesser extent than non-diabetic patients. Dia betic patients treated with oral hypoglycaemic agents or insulin, but not t hose treated with diet alone, have a significantly increased mortality foll owing acute myocardial infarction compared with non-diabetic patients. (C) 2000 The European Society of Cardiology.