Management and short-term outcome of diabetic patients hospitalized for acute myocardial infarction: results of a nationwide French survey.
OBJECTIVE
To compare management and short-term outcome of diabetic and non-diabetic patients hospitalized for acute myocardial infarction.


METHODS
This was a prospective epidemiological survey. All patients admitted in coronary care units in France in November 2000 for confirmed acute myocardial infarction were eligible to enter the study.


RESULTS
Of the 2320 patients recruited from 369 centers, 487 were diabetic (21%). Compared to non-diabetic patients, diabetic patients were 5 years older, more often female, obese and hypertensive; they had more often a history of cardiovascular disease; they had a lower ejection fraction and worse Killip class. Reperfusion therapy was less frequent among diabetic patients (39% versus 51%; p=0.0001), as was the use of beta-blockers (61% versus 72%; p=0.0001), aspirin (83% versus 89%; p=0.0001) and statins (52% versus 60%; p=0.001) during hospitalization. Conversely, the use of ACE-inhibitors was more frequent (54% versus 44%; p=0.0001). 58% of diabetic patients received insulin during hospitalization. Twenty-eight-day mortality was 13.1% in diabetic patients and 7.0% in non-diabetic patients (risk ratio: 1.87; p=0.001). Diabetes remained associated with increased mortality after adjustment for relevant risk factors including age and ejection fraction (risk ratio: 1.51; p=0.07). In patients treated with antidiabetic drugs (chiefly sulfonylureas) before admission, 28-day mortality was 10.4% compared with 19.9% in diabetic patients on diet alone or untreated (p=0.005).


CONCLUSIONS
Despite higher cardiovascular risk and worse prognosis, in-hospital management of diabetic patients with acute myocardial infarction remains sub-optimal. Patients previously treated with antidiabetic drugs including sulfonylureas had a better prognosis than untreated diabetic patients.
Vaur
L
L
Medical Department, Aventis, Paris, France. laurent.vaur@aventis.com
Danchin
N
N
Hanania
G
G
Cambou
J P
JP
Lablanche
J M
JM
Blanchard
D
D
Clerson
P
P
Gueret
P
P
D000319:Adrenergic beta-Antagonists / Q000627:therapeutic use; D000368:Aged; D001241:Aspirin / Q000627:therapeutic use; D015992:Body Mass Index; D003925:Diabetic Angiopathies / Q000188:drug therapy / Q000628:therapy*; D005260:Female; D005602:France; D006306:Health Surveys; D006760:Hospitalization; D006801:Humans; D006937:Hypercholesterolemia / Q000453:epidemiology; D007328:Insulin / Q000627:therapeutic use; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000517:prevention & control / Q000628:therapy*; D015425:Myocardial Reperfusion; D011237:Predictive Value of Tests; D012307:Risk Factors; D012907:Smoking; D020521:Stroke / Q000453:epidemiology; D015912:Thrombolytic Therapy; D013997:Time Factors; D016896:Treatment Outcome
D000319:Adrenergic beta-Antagonists; D007328:Insulin; D001241:Aspirin