Arrhythmias and mortality after myocardial infarction in diabetic patients. Relationship to diabetes treatment.
OBJECTIVE
To assess the relationship between clinical course after acute myocardial infarction (AMI) and diabetes treatment.


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.
Davis
T M
TM
Department of Medicine, Fremantle Hospital, University of Western Australia, Australia. tdavis@cyllene.uwa.edu.au
Parsons
R W
RW
Broadhurst
R J
RJ
Hobbs
M S
MS
Jamrozik
K
K
D000328:Adult; D001145:Arrhythmias, Cardiac / Q000453:epidemiology*; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000188:drug therapy* / Q000401:mortality; D004071:Digitalis Glycosides / Q000627:therapeutic use; D004232:Diuretics / Q000627:therapeutic use; D005260:Female; D005907:Gliclazide / Q000627:therapeutic use; D006327:Heart Block / Q000453:epidemiology; D006801:Humans; D006973:Hypertension; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications* / Q000188:drug therapy / Q000401:mortality*; D016017:Odds Ratio; D011654:Pulmonary Edema / Q000453:epidemiology; D012044:Regression Analysis; D012189:Retrospective Studies; D012907:Smoking; D015996:Survival Rate; D013997:Time Factors
D004071:Digitalis Glycosides; D004232:Diuretics; D007004:Hypoglycemic Agents; D007328:Insulin; D008687:Metformin; D005907:Gliclazide