Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus.
Aims To compare short- and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32-1.81, 5-year HR 2.01; 95% CI 1.84-2.21) and women (28-day HR 1.19; 95% CI 1.03-1.37, 5-year HR 1.53; 95% CI 1.40-1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99-1.36, 5-year HR 1.49; 95% CI 1.36-1.64) and women (28-day HR 1.12; 95% CI 0.97-1.28, 5-year HR 1.39; 95% CI 1.27-1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.
Koek
H L
HL
Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, HPN Str. 06.131, P.O. Box 85.060, 3508, AB, Utrecht, The Netherlands.
Soedamah-Muthu
S S
SS
Kardaun
J W P F
JW
Gevers
E
E
de Bruin
A
A
Reitsma
J B
JB
Bots
M L
ML
Grobbee
D E
DE
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D048909:Diabetes Complications / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000453:epidemiology / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009203:Myocardial Infarction / Q000150:complications / Q000453:epidemiology / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology; D018570:Risk Assessment; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors