title: Trends in postacute myocardial infarction management and mortality in patients with diabetes. A population-based study from 1995 to 2001.
abstract: OBJECTIVE
  To compare trends in coronary revascularization use and case fatality rate (CFR) following acute myocardial infarction in patients with and without diabetes.
  
  
  METHODS
  A retrospective study of 77,552 patients, 20 years of age or older (25% with diabetes), who were hospitalized for a first acute myocardial infarction in the province of Quebec between April 1995 and December 2001 was conducted. Administrative databases were used to identify patients and assess outcomes.
  
  
  RESULTS
  Compared with patients without diabetes, patients with diabetes underwent more coronary artery bypass graft (CABG) surgeries (11.1% versus 8.3%; P<0.0001) but fewer percutaneous coronary interventions (17.1% versus 20.2%; P<0.0001). The use of percutaneous coronary intervention increased substantially over time in both populations, driven mainly by an increase during the index admission (20.6% versus 16.6% per year; P=0.1144 in patients with and without diabetes, respectively). The use of CABG during the index admission increased markedly among patients with diabetes compared with those without (10.3% versus 5.3% per year; P=0.0072); however, at one-year following discharge, CABG use remained stable in patients with diabetes and fell in those without (-0.7% versus -5.3% per year; P=0.2046). Concomitantly, patients with diabetes presented a similar decline in CFR compared with patients without diabetes. The decline was more pronounced during the index admission (-5.0% versus -4.1% per year; P=0.282) than at one-year following discharge (-2.5% versus -2.5% per year; P=0.629) in patients with and without diabetes, respectively. However, fatal outcome remained higher in patients with diabetes than without, with an adjusted RR of 1.21 (95% CI 1.18 to 1.24) at one-year follow-up.
  
  
  CONCLUSIONS
  Overall, coronary revascularization use and CFR improved over time in patients with diabetes. Nevertheless, the mortality rate in patients with diabetes remains higher than in patients without diabetes, indicating that additional progress is required to improve the poorer prognosis in this population.
authors.affiliation: National Public Health Institute of Quebec, Laval University, Canada.
authors.forename: Najwa
authors.initials: N
authors.lastname: Ouhoummane
authors.forename: Belkacem
authors.initials: B
authors.lastname: Abdous
authors.forename: Rabia
authors.initials: R
authors.lastname: Louchini
authors.forename: Louis
authors.initials: L
authors.lastname: Rochette
authors.forename: Paul
authors.initials: P
authors.lastname: Poirier
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009203:Myocardial Infarction / Q000401:mortality* / Q000628:therapy*; D009204:Myocardial Revascularization; D012189:Retrospective Studies; D016896:Treatment Outcome