Long-term, cause-specific mortality after myocardial infarction in diabetes

AIMS: To compare long-term, cause-specific mortality after reperfusion therapy for ST segment elevation myocardial infarction (STEMI) in patients with and without diabetes. METHODS AND RESULTS: Patients with STEMI (n = 395) were randomised to intravenous streptokinase (SK) or primary percutaneous coronary intervention (PCI). Median follow-up was 7.5 years (interquartile range 5.6-8.5). A total of 74 patients (19%) had diabetes. Reduced left ventricular ejection fraction (<40%) after STEMI was more often observed in patients with diabetes (27% vs. 15%, P = 0.02). Patients with diabetes had a higher total mortality compared to patients without diabetes (HR 2.4; P < 0.001). Multivariate analysis confirmed that diabetes was an independent risk factor for long-term mortality (HR 2.3; P < 0.001). The incidence of sudden death was comparable in both patient groups (HR 1.6; P = 0.23). The increased mortality in patients with diabetes was mainly caused by heart failure (HR 3.1; P = 0.004). In patients with diabetes, primary PCI was associated with an improved prognosis. CONCLUSIONS: Despite reperfusion therapy, STEMI patients with diabetes have an increased long-term mortality. This is due to death by heart failure and not by an increase in sudden death. Primary PCI is associated with an improved prognosis, particularly in patients with diabetes.