Five-Year Outcomes after Acute Myocardial Infarction in Patients with and without Diabetes Mellitus in Taiwan, 1996-2005.
BACKGROUND
Diabetes mellitus (DM) is a strong risk factor of cardiovascular disease. To date, the impact of DM on outcomes after acute myocardial infarction (AMI) in Taiwan is undetermined. The aim of this study was to compare five-year outcomes after AMI in patients with and without diabetes in Taiwan.


METHODS
A nationwide cohort of 25,028 diabetic and 56,028 non-diabetic patients who were first hospitalized with AMI between 1996 and 2005 was enrolled through linkage with the Taiwan National Health Insurance research database. Patient mortality rates within 30 days after AMI, and 1, 3, and 5 years thereafter were compared.


RESULTS
Length of hospital stay (8.9 ± 8.7 vs. 8.2 ± 8.0 days, p < 0.01) and medical cost during admission (in Taiwan dollars: $129,123 ± $158,073 vs. $121,631 ± $157,018, p < 0.01) were significantly higher in diabetic patients. The difference in mortality rate within 30 days was insignificant between diabetic and non-diabetic patients (18.1% vs. 17.6%, p = 0.06). Mortalities within 1 year (31.0% vs. 26.8%, p < 0.01), 3 years (42.4% vs. 34.7%, p < 0.01), and 5 years (50.6% vs. 41.1%, p < 0.01) were significantly higher in diabetic patients. In patients with AMI who underwent percutaneous coronary intervention (PCI) during index admission, the mortality rate within 30 days was insignificant (6.3% vs. 6.4%, p = 0.70) but mortalities within 1 year (15.2% vs. 11.6%, p < 0.01), 3 years (24.1% vs. 17.2%, p < 0.01), and 5 years (32.2% vs. 22.6%, p < 0.01) were significantly higher in diabetic patients.


CONCLUSIONS
The average patient length of hospital stay and medical cost during admission were significantly higher in diabetic patients. Additionally, the difference in mortality rate within 30 days after AMI was insignificant between diabetic and non-diabetic patients. Also, long-term mortality after AMI was significantly higher in diabetic patients.


BACKGROUND
Acute myocardial infarction; Diabetes mellitus; Length of hospital stay; Medical cost; Mortality; National health insurance.
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung;
Cheng-Hung
CH
Chiang
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; School of Medicine, National Yang-Ming University, Taipei; ; Department of Physical Therapy, Fooyin University;
Wei-Chun
WC
Huang
Department of Physical Therapy, Fooyin University;
Jin-Shiou
JS
Yang
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; School of Medicine, National Yang-Ming University, Taipei;
Chin-Chang
CC
Cheng
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital;
Feng-Yu
FY
Kuo
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; School of Medicine, National Yang-Ming University, Taipei;
Kuan-Rau
KR
Chiou
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital;
Tao-Yu
TY
Lee
Cheng Shiu University;
Tzu-Wen
TW
Lin
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital;
Guang-Yuan
GY
Mar
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; School of Medicine, National Yang-Ming University, Taipei;
Chuen-Wang
CW
Chiou
Cardiovascular Medical Center, Kaohsiung Veterans General Hospital; ; School of Medicine, National Yang-Ming University, Taipei;
Chun-Peng
CP
Liu
Graduate Institute of Healthcare Administration, Kaohsiung Medical University, Kaohsiung; ; Department of Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
King-Teh
KT
Lee