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

Strandberg L‐E, Ericsson C‐G, O’Konor M‐L, Bergstrand L, Lundin P, Rehnqvist N, Tornvall P (Norrtälje Hospital, Danderyd Hospital, the Swedish National Board of Health, Karolinska Hospital and the Karolinska Institute, Stockholm, Sweden). Diabetes mellitus is a strong negative prognostic factor in patients with myocardial infarction treated with thrombolytic therapy. J Intern Med 2000; 248: 119–125. Objectives. To assess the long‐term prognostic values of baseline demographic data, occurrence of vectorcardiographic signs of reperfusion, left ventricular 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 acute myocardial infarction treated with thrombolysis were investigated and followed 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 mellitus ( 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 or a new myocardial infarction in univariate analysis. Sex, a previous history of smoking or angina pectoris, vectorcardiographic signs of reperfusion or degree of coronary artery disease had no prognostic values. In multivariate analysis including age above 55 years, a previous diagnosis of diabetes mellitus, hypertension and myocardial infarction, and an ejection fraction 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 infarction. Conclusions. The results of the present study emphasize the importance of diabetes mellitus as a long‐term prognostic risk factor in patients with myocardial infarction treated with thrombolysis. Further studies are needed to determine the mechanisms behind this increased risk.