The relation of diabetes to the severity of acute myocardial infarction and post-myocardial infarction survival in Mexican-Americans and non-Hispanic whites. The Corpus Christi Heart Project.
The effect of diabetes on survival after myocardial infarction (MI) was examined in a prospective population-based study of individuals hospitalized with MI in a bi-ethnic community of Mexican-Americans and non-Hispanic whites. Among Mexican-Americans, 54% (331 of 610) had diabetes compared with 33% (192 of 589) of non-Hispanic whites (P < 0.001). Among those with diabetes, the prevalence of a history of a cardiac event before the index admission was significantly higher (odds ratio = 1.4, 95% confidence interval [CI] 1.1-1.8) than among nondiabetic subjects. During the index hospitalization, diabetic subjects received cardiac catheterization less frequently than did nondiabetic subjects (45.1 vs. 51.5%, P = 0.03). Diabetic subjects had lower estimated ejection fractions, and the number of coronary arteries with significant obstruction (> 75%) was higher (P < 0.001). The peak creatine phosphokinase and creatine phosphokinase myocardial isoenzyme (CK-MB) levels were similar in diabetic and nondiabetic subjects. Despite a similar infarct size, diabetic subjects had a higher incidence of congestive heart failure (relative ratio = 2.2, 95% CI 1.7-2.8), more adverse indexes of short-term and long-term prognosis, and a longer average hospital stay (12.1 vs. 8.9 days, P < 0.01). After adjustment for age, sex, and ethnicity, the cumulative risk for total mortality, over 44 months of follow-up, was 37.4% among diabetic compared with 23.3% among nondiabetic subjects (P < 0.001). Diabetic subjects had a higher 28-day case-fatality rate post-MI as well as higher long-term mortality.(ABSTRACT TRUNCATED AT 250 WORDS)
Orlander
P R
PR
Department of Medicine, University of Texas Medical School at Houston 77030.
Goff
D C
DC
Morrissey
M
M
Ramsey
D J
DJ
Wear
M L
ML
Labarthe
D R
DR
Nichaman
M Z
MZ
D000328:Adult; D000368:Aged; D003402:Creatine Kinase / Q000097:blood; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006760:Hospitalization; D006801:Humans; D015994:Incidence; D007527:Isoenzymes; D008297:Male; D017058:Mexican Americans; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality* / Q000503:physiopathology*; D011379:Prognosis; D011446:Prospective Studies; D012727:Sex Characteristics; D012737:Sex Factors; D015996:Survival Rate; D013781:Texas; D013997:Time Factors; D044465:White People
D007527:Isoenzymes; D003402:Creatine Kinase