Cardiovascular medicine
Impact of diabetes mellitus on long term survival after acute
myocardial infarction in patients with single vessel disease
M Ishihara, H Sato, T Kawagoe, Y Shimatani, S Kurisu, K Nishioka, Y Kouno, T Umemura, S Nakamura
Department of
Cardiology, Hiroshima City Hospital, 7-33 Moto-machi, Naka-ku,
Hiroshima 730-8518, Japan
Correspondence to: Dr Ishihara ishifami{at}fb3.so-net.ne.jp
Accepted 20 February 2001
OBJECTIVE
To assess the influence of
diabetes on long term prognosis after reperfusion treatment and its
interaction with multivessel disease.
DESIGNA retrospective observational study.
SETTINGHiroshima City Hospital.
PATIENTS1660 consecutive patients
with acute myocardial infarction who underwent coronary angiography
within 24 hours after the onset of chest pain.
MAIN OUTCOME MEASURESInfluence of
diabetes on 10 year survival after infarction was assessed using the
generalised Wilcoxon test and Cox's proportional hazards regression.
Follow up was completed in 1622 patients (98%).
RESULTSDiabetic patients had more
multivessel disease than non-diabetic patients (53%
v 34%, p < 0.001). When only patients with single vessel disease were compared, diabetes was associated with a
reduced 10 year survival after infarction (p = 0.002). On the other
hand, in patients with multivessel disease there was no significant
difference in survival between diabetic and non-diabetic patients
(p = 0.70). Multivariate analysis also showed that diabetes was an
independent risk factor related to 10 year mortality after infarction
in patients with single vessel disease (odds ratio (OR) 1.81, 95%
confidence interval (CI) 1.27 to 2.54; p = 0.001) and not in patients
with multivessel disease (OR 1.17, 95% CI 0.85 to 1.60; p = 0.34).
CONCLUSIONSDiabetes is an
independent predictor of long term mortality after infarction in
patients with single vessel disease. However, in the presence of
multivessel disease, prognosis after infarction is impaired regardless
of diabetes, and the influence of diabetes is less obvious.
Keywords: myocardial infarction; diabetes; coronary angiography
© 2001 by Heart
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