title: Short- and long-term mortality after myocardial infarction in patients with and without diabetes: changes from 1985 to 2008.
abstract: OBJECTIVE
  To study temporal trends in short- and long-term outcome after myocardial infarction (MI) according to diabetes status.
  
  
  METHODS
  We included all 14,434 consecutive patients admitted for ST-segment elevation MI or non-ST-segment elevation MI at our center between 1985 and 2008. The study patients were compared according to prevalent diabetes. Temporal trend analyses were performed by comparing decades of admission (1985-1989 vs. 1990-1999 vs. 2000-2008).
  
  
  RESULTS
  A total of 2,015 (14%) of the patients had prevalent diabetes. The risk of presenting with diabetes increased from 8 to 17% from 1985 to 2008. Diabetic patients presented with a higher prevalence of cardiovascular risk factors. With time, the use of evidence-based therapies increased in both patients with and without diabetes. Diabetes is associated with a 1.5-fold increased risk of mortality at the 20-year follow-up. Ten-year mortality decreased over time in patients with diabetes, from 53% in 1985-1989 to 39% in 2000-2008 (adjusted hazard ratio 0.56 [95% CI 0.43-0.73]), and in those without diabetes, from 38% in 1985-1989 to 29% in 2000-2008 (0.66 [0.60-0.73]; P interaction = 0.83). Patients with diabetes benefitted from a higher 30-day and 10-year absolute survival increase.
  
  
  CONCLUSIONS
  Temporal mortality reductions after MI between 1985 and 2008 were at least as high in patients with diabetes compared with those without diabetes. However, long-term mortality remained higher in diabetic patients. Awareness of the high-risk profile of diabetic patients is warranted and might stimulate optimal medical care and outcome.
authors: Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands.
authors: Sjoerd T
authors: ST
authors: Nauta
authors: Jaap W
authors: JW
authors: Deckers
authors: K Martijn
authors: KM
authors: Akkerhuis
authors: Ron T
authors: RT
authors: van Domburg
mesh_terms: D000328:Adult; D048909:Diabetes Complications / Q000401:mortality*; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D009426:Netherlands / Q000453:epidemiology