title: An evaluation of 20 year survival in patients with diabetes mellitus and acute myocardial infarction.
abstract: BACKGROUND
  Diabetes mellitus (DM) is an established adverse prognostic factor in patients sustaining myocardial infarction (MI). However, its impact on long-term survival remains less clear. The aim of this observational study was to quantify lifetime mortality and years of life lost after MI in patients with and without DM.
  
  
  METHODS
  In 1995, 2153 individuals with MI were recruited from 20 adjacent hospitals within Yorkshire, UK. Median survival, all-cause mortality at 20 years and lost years of life when compared to actuarial predictions were compared in patients with and without DM. Landmark analyses were conducted to define the ongoing impact of DM beyond specified time points.
  
  
  RESULTS
  13% (279/2153) had known DM. They experienced higher mortality at 30 days (33.1% vs 24.6%; p<0.0001) and at 20 years (84.9% vs 75.7%; p<0.0001). Overall, there was a 48% increased risk of death (p<0.0001), which persisted after adjustment for potential confounders. There was no interaction between DM and prior MI in predicting mortality (p=0.67). Median survival decreased by 3.3 years (p<0.0001). The adverse impact of DM persisted in sequential landmark analyses at 1, 5 and 10 years. Presence of DM conferred 2 extra years of life lost when compared with actuarial predictions (8 vs 6 years; p<0.0001).
  
  
  CONCLUSIONS
  DM remains an independent adverse prognostic factor in the long-term after MI. Persistently diverging survival curves support enduring efforts to reduce mortality late after MI.
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
authors.forename: Peysh A
authors.initials: PA
authors.lastname: Patel
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
authors.forename: Richard M
authors.initials: RM
authors.lastname: Cubbon
authors.affiliation: Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Sapsford
authors.affiliation: Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom.
authors.forename: Richard G
authors.initials: RG
authors.lastname: Gillott
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Grant
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
authors.forename: Klaus K
authors.initials: KK
authors.lastname: Witte
authors.affiliation: Leeds Institute of Cardiovascular and Metabolic Medicine, LIGHT Laboratories, The University of Leeds, Clarendon Way, Leeds LS2 9JT, United Kingdom.
authors.forename: Mark T
authors.initials: MT
authors.lastname: Kearney
authors.affiliation: Department of Cardiology, Leeds General Infirmary, Great George Street, Leeds LS1 3EX, United Kingdom. Electronic address: A.S.Hall@leeds.ac.uk.
authors.forename: Alistair S
authors.initials: AS
authors.lastname: Hall
mesh_terms: D000328:Adult; D017677:Age Distribution; D000368:Aged; D003920:Diabetes Mellitus / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D005544:Forecasting; D006801:Humans; D008017:Life Expectancy / Q000639:trends; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000150:complications / Q000401:mortality*; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate / Q000639:trends; D006113:United Kingdom / Q000453:epidemiology
keywords: Acute myocardial infarction; Diabetes; Life expectancy; Mortality