Key result
Diabetes was associated with significantly higher 28-day mortality after acute myocardial infarction compared to nondiabetic patients (28.1% vs 12.0%, P<0.001), with no significant drug effects.
Why the study?
Does the type of diabetes treatment affect short- and long-term survival and complications in diabetic patients following acute myocardial infarction?
Cohort (n=5,715)
Yes
Does the type of diabetes treatment affect short- and long-term survival and complications in diabetic patients following acute myocardial infarction?
Absolute Event Rate: 28.1% vs 12%
p-value: p=<0.001
The type of diabetes treatment, including specific sulfonylureas, does not significantly impact short- or long-term survival after acute myocardial infarction, suggesting ischemic heart disease should not dictate the choice of diabetes regimen.
Diabetes linked to higher post-MI mortality across therapies; leaves open whether regimen choice modifies risk.
OBJECTIVE: To assess the relationship between clinical course after acute myocardial infarction (AMI) and diabetes treatment. RESEARCH DESIGN AND METHODS: Retrospective analysis of data from all patients aged 25-64 years admitted to hospitals in Perth, Australia, between 1985 and 1993 with AMI diagnosed according to the International Classification of Diseases (9th revision) criteria was conducted. Short- (28-day) and long-term survival and complications in diabetic and nondiabetic patients were compared. For diabetic patients, 28-day survival, dysrhythmias, heart block, and pulmonary edema were treated as outcomes, and factors related to each were assessed using multiple logistic regression. Diabetes treatment was added to the model to assess its significance. Long-term survival was compared by means of a Cox proportional hazards model. RESULTS: Of 5,715 patients, 745 (12.9%) were diabetic. Mortality at 28 days was 12.0 and 28.1% for nondiabetic and diabetic patients, respectively (P < 0.001); there were no significant drug effects in the diabetic group. Ventricular fibrillation in diabetic patients taking glibenclamide (11.8%) was similar to that of nondiabetic patients (11.0%) but was lower than that for those patients taking either gliclazide (18.0%; 0.1 > P > 0.05) or insulin (22.8%; P < 0.05). There were no other treatment-related differences in acute complications. Long-term survival in diabetic patients was reduced in those taking digitalis and/or diuretics but type of diabetes treatment at discharge had no significant association with outcome. CONCLUSIONS: These results do not suggest that ischemic heart disease should influence the choice of diabetes treatment regimen in general or of sulfonylurea drug in particular.
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Davis et al. (1998) conducted a cohort in Acute myocardial infarction (n=5,715). Diabetes and diabetes treatments vs. Nondiabetic patients was evaluated on Mortality at 28 days (p=<0.001). Diabetes was associated with significantly higher 28-day mortality after acute myocardial infarction compared to nondiabetic patients (28.1% vs 12.0%, P<0.001), with no significant drug effects.
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