[The destiny of persons with diabetes mellitus type 2 after first myocardial infarction--analysis of the cohort living in well defined environment].
Ischemic heart disease (IHD) and acute myocardial infarction (AMI) present several important specificities in their clinical course. The problem how these circumstances influence the life of the persons with diabetes (DM) in longer perspective is not well elaborated. Therefore the assessment of the medical history of persons with DM after first MI was undertaken based on analysis of the following endpoints: the recurrence of MI, hospitalization due to acute heart ischemic incidents, the procedure of coronary revascularization, appearance of stroke, death due to cardiovascular causes.


METHODS
During the years 1996-2000 69 subjects with AMI were hospitalized from the area of the local, urban hospital. The medical documentation supplemented by the patient and family home reviews and data from death registry office for the period of 2 years since the hospitalization due to first AMI was analyzed.


RESULTS
In the group under study the males aged between 61 and 70 years were preponderant - 20,3%, the largest females subgroup was in the age between 71 and 80 years - 17,4%. The first AMI was the revelatory of the previously not known DM in 30,4% of cases, 21,7% subjects had the diagnosis of DM made in the last 5 years before first AMI. The symptoms of IHD were present before first AMI in 49% of subjects. 82% of them had the Q type AMI in 23% localized in inferior, in 17% in anterior and in 16% in lower-posterior wall of the heart. The frequencies of other then hyperglycaemia risk factors were: arterial hypertension - 67%, obesity and overweight respectively 38% and 26%, smoking - 32%, dyslipidemia - 28%. The risk factors were often multiple in the form of metabolic syndrome. During the 2 years of the follow-up after first AMI, 34,6% of subjects died. In 72,2% of this subgroup the mortality was due to the cardiovascular syndromes - recurrent MI, cardiac failure, stroke and "generalized atherosclerosis". The rate of hospitalization caused by acute ischemic incidents was 25%, recurrent MI - 11,5%, cardiosurgical intervention - 5,8%, stroke - 3,8%.


CONCLUSIONS
The mortality level of 34,6% during 2 years after first AMI due to new cardiovascular events is the measure of the specific unfavourable prognosis for diabetic persons after first AMI. It underlines the need of the implementation in this subgroup of the intensified cardio-diabetological secondary prevention plan.
Głowania
Ismena
I
Katedra i Klinika Chor6b Wewnetrznych i Diabetologii II Wydziału Lekarskiego Akademii Medycznej w Warszawie. ismena@interia.pl
Czech
Anna
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003925:Diabetic Angiopathies / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy; D017202:Myocardial Ischemia / Q000453:epidemiology*; D011044:Poland / Q000453:epidemiology; D011379:Prognosis; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D020521:Stroke / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D014505:Urban Population