title: Do differences in baseline characteristics or in management account for the poorer in-hospital and subsequent outcome after myocardial infarction in diabetics? Data from a large unselected cohort.
abstract: OBJECTIVE
  There is an excess mortality after myocardial infarction in diabetics, but also documented significant differences in the characteristics of MI and in management between diabetics and non-diabetics. The aim of this prospective study in a large unselected patient cohort in a single French region was to determine if baseline characteristics, management, or in-hospital and one-year mortality differed in diabetic and non-diabetic patients with myocardial infarction.
  
  
  RESULTS
  Data were prospectively collected in consecutive patients with myocardial infarction admitted to all hospitals in three departments in the Rhone-Alpes region between September 1, 1993 and January 31,1995. Among the 2,297 patients, 410 patients (17.8%) were diabetic. Although diabetics were older than non-diabetics (70.3 vs. 67.8 years; p < 0.0004), and less likely to receive thrombolysis (31% vs. 36%; p = 0.043), in-hospital mortality was not significantly higher (17.3% vs. 14.7%) than in non-diabetics. In multivariate analysis, diabetes was a significant predictor of one-year mortality (relative risk: 1.41; 95% CI = 1.10 - 1.79; p = 0.0063) but not of in-hospital mortality (relative risk: 1.2; 95% CI = 0.9 - 1.7; p = 0.25). Multivariate predictors of in-hospital and one-year mortality in diabetics were age and Killip class at admission.
  
  
  CONCLUSIONS
  In this large unselected French cohort, diabetes mellitus was a significant predictor of one-year but not of in-hospital mortality after myocardial infarction in a French region. This negative effect of diabetes on mortality was not related to differences in baseline characteristics, or in initial or post-discharge management between diabetics and non-diabetics.
authors.affiliation: Hĵpital Cardiovasculaire et Pneumologique Louis Pradel BP Lyon Montchat, Lyon, France. guy.de-gevigney@chu-lyon.fr
authors.forename: Guy
authors.initials: G
authors.lastname: de Gevigney
authors.forename: Danièle
authors.initials: D
authors.lastname: Cao
authors.forename: Eugène
authors.initials: E
authors.lastname: Macfadden
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.forename: Muriel
authors.initials: M
authors.lastname: Rabilloud
authors.forename: Edouard
authors.initials: E
authors.lastname: Cheneau
authors.forename: Hugues
authors.initials: H
authors.lastname: Milon
authors.forename: François
authors.initials: F
authors.lastname: Delahaye
mesh_terms: D000368:Aged; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000453:epidemiology; D005260:Female; D005602:France / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D015995:Prevalence; D011446:Prospective Studies; D015912:Thrombolytic Therapy