title: Long-term prognosis of diabetic patients with acute myocardial infarction in the era of acute revascularization.
abstract: BACKGROUND
  The long-term prognosis of diabetic patients with acute myocardial infarction (AMI) treated by acute revascularization is uncertain, and the optimal pharmacotherapy for such cases has not been fully evaluated.
  
  
  METHODS
  To elucidate the long-term prognosis and prognostic factors in diabetic patients with AMI, a prospective, cohort study involving 3021 consecutive AMI patients was conducted. All patients discharged alive from hospital were followed to monitor their prognosis every year. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was the occurrence of major cardiovascular events. To elucidate the effect of various factors on the long-term prognosis of AMI patients with diabetes, the patients were divided into two groups matched by propensity scores and analyzed retrospectively.
  
  
  RESULTS
  Diabetes was diagnosed in 1102 patients (36.5%). During the index hospitalization, coronary angioplasty and coronary thrombolysis were performed in 58.1% and 16.3% of patients, respectively. In-hospital mortality of diabetic patients with AMI was comparable to that of non-diabetic AMI patients (9.2% and 9.3%, respectively). In total, 2736 patients (90.6%) were discharged alive and followed for a median of 4.2 years (follow-up rate, 96.0%). The long-term survival rate was worse in the diabetic group than in the non-diabetic group, but not significantly different (hazard ratio, 1.20 [0.97-1.49], p = 0.09). On the other hand, AMI patients with diabetes showed a significantly higher incidence of cardiovascular events than the non-diabetic group (1.40 [1.20-1.64], p < 0.0001). Multivariate analysis revealed that three factors were significantly associated with favorable late outcomes in diabetic AMI patients: acute revascularization (HR, 0.62); prescribing aspirin (HR, 0.27); and prescribing renin-angiotensin system (RAS) inhibitors (HR, 0.53). There was no significant correlation between late outcome and prescription of beta-blockers (HR, 0.97) or calcium channel blockers (HR, 1.27). Although standard Japanese-approved doses of statins were associated with favorable outcome in AMI patients with diabetes, this was not statistically significant (0.67 [0.39-1.06], p = 0.11).
  
  
  CONCLUSIONS
  Although diabetic patients with AMI have more frequent adverse events than non-diabetic patients with AMI, the present results suggest that acute revascularization and standard therapy with aspirin and RAS inhibitors may improve their prognosis.
authors.affiliation: Division of Cardiology, Saiseikai Kurihashi Hospital, Saitama, Japan.
authors.forename: Ayako
authors.initials: A
authors.lastname: Takara
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Ogawa
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Endoh
authors.forename: Fumiaki
authors.initials: F
authors.lastname: Mori
authors.forename: Jun-ichi
authors.initials: J
authors.lastname: Yamaguchi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Takagi
authors.forename: Ryo
authors.initials: R
authors.lastname: Koyanagi
authors.forename: Tsuyoshi
authors.initials: T
authors.lastname: Shiga
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kasanuki
authors.forename: Nobuhisa
authors.initials: N
authors.lastname: Hagiwara
mesh_terms: D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D001026:Coronary Artery Bypass / Q000401:mortality / Q000706:statistics & numerical data; D003925:Diabetic Angiopathies / Q000601:surgery*; D006801:Humans; D009203:Myocardial Infarction / Q000601:surgery*; D009204:Myocardial Revascularization / Q000379:methods* / Q000639:trends; D011379:Prognosis; D012189:Retrospective Studies; D016019:Survival Analysis; D017741:Survivors / Q000706:statistics & numerical data*