Intensification of therapeutic approaches reduces mortality in diabetic patients with acute myocardial infarction: the Munich registry.
OBJECTIVE
The myocardial infarction (MI) registry of the Academic Schwabing Hospital, Munich, investigates the hospital course of diabetic and nondiabetic patients with acute MI. The aim of this study was to improve quality care management and to compare hospital mortality and therapeutic approaches (i.e., PTCA, stenting, GPIIb/IIIa receptor antagonists, glucose-insulin infusion).


METHODS
Data of diabetic patients and nondiabetic patients were analyzed. All diabetic and nondiabetic subjects who were admitted in 1999 and 2001 were included: 1999, 126 (38%) diabetic and 204 (62%) nondiabetic patients; 2001, 91 (31%) diabetic and 205 (59%) nondiabetic patients.


RESULTS
In 1999, coronary angiography (P < 0.01), percutaneous transluminal coronary angioplasty (PTCA) (P < 0.001), and stenting (P < 0.001) were performed less frequently in diabetic than in nondiabetic patients. During this period, total hospital mortality (29 vs. 16%, P < 0.01) and mortality within 24 h after admission (14 vs. 5%, P = 0.01) were higher in diabetic than in nondiabetic patients. In 2001, frequencies of coronary angiography, PTCA, and stenting were increased in diabetic patients (P < 0.001 vs. 1999), and the interventions were comparable with those performed in nondiabetic patients. Furthermore, glucose-insulin infusion was administered in 46% of diabetic subjects. In 2001, total hospital mortality decreased to 17% in diabetic subjects (P = 0.028 vs. 1999) and mortality within 24 h after admission declined to 4% (P = 0.027 vs. 1999). Logistic regression analysis revealed that an increase in the number of therapeutic approaches (also when adjusted for clinical variables) is associated with a reduction in mortality of diabetic patients with acute MI (adjusted odds ratio 0.14, P < 0.0001).


CONCLUSIONS
Intensification of multiple advanced therapeutic strategies in diabetic patients with acute MI enables a substantial reduction in hospital mortality. The enforcement leads to rates of hospital mortality that are comparable to those of nondiabetic patients.
Schnell
Oliver
O
Diabetes Research Institute, and Third Medical Clinic, Academic Schwabing-Hospital, Munich, Germany. oliver.schnell@lrz.uni-muenchen.de
Schäfer
Oliver
O
Kleybrink
Sonja
S
Doering
Wittich
W
Standl
Eberhard
E
Otter
Wolfgang
W
D015906:Angioplasty, Balloon, Coronary / Q000706:statistics & numerical data; D000818:Animals; D017023:Coronary Angiography / Q000706:statistics & numerical data; D001026:Coronary Artery Bypass / Q000706:statistics & numerical data; D003925:Diabetic Angiopathies / Q000401:mortality* / Q000628:therapy*; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D012307:Risk Factors; D015607:Stents / Q000706:statistics & numerical data; D016019:Survival Analysis
D005343:Fibrinolytic Agents