title: Long-term mortality after acute myocardial infarction among individuals with and without diabetes: A systematic review and meta-analysis of studies in the post-reperfusion era.
abstract: To conduct a systematic review and meta-analysis with the aim of providing robust estimates of the association between diabetes and long-term (≥1 year) mortality after acute myocardial infarction (AMI).
  
  
  
  Medline, Embase and Web of Science databases were searched (January 1985 to July 2016) for terms related to long-term mortality, diabetes and AMI. Two authors independently abstracted the data. Hazard ratios (HRs) comparing mortality in people with and without diabetes were pooled across studies using Bayesian random-effects meta-analysis.
  
  
  
  A total of 10 randomized controlled trials and 56 cohort studies, including 714 780 patients, reported an estimated total of 202 411 deaths over the median (range) follow-up of 2.0 (1-20) years. The risk of death over time was significantly higher among those with diabetes compared with those without (unadjusted HR 1.82, 95% credible interval [CrI] 1.73-1.91). Mortality remained higher in the analysis restricted to 23/64 cohorts reporting data adjusted for confounders (adjusted HR 1.48, 95% CrI 1.43-1.53). The excess long-term mortality in diabetes was evident irrespective of the phenotype and modern treatment of AMI, and persisted in early survivors (unadjusted HR 1.82, 95% CrI 1.70-1.95).
  
  
  
  Despite medical advances, individuals with diabetes have a 50% greater long-term mortality compared with those without. Further research to understand the determinants of this excess risk are important for public health, given the predicted rise in global diabetes prevalence.
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.|Department of Health Sciences, University of Leicester, Leicester, UK.|Department of Diabetes, Endocrinology and Metabolism, University Hospitals Coventry and Warwickshire, NHS Trust, Coventry, UK.
authors.forename: Nitin N
authors.initials: NN
authors.lastname: Gholap
authors.affiliation: Clinical Trials Unit, University of Warwick, Coventry, UK.
authors.forename: Felix A
authors.initials: FA
authors.lastname: Achana
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.|Leicester Clinical Trials Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK.|Lifestyle and Physical Activity Biomedical Research Unit, Leicester-Loughborough NIHR Diet, Leicester, UK.|NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK.
authors.forename: Melanie J
authors.initials: MJ
authors.lastname: Davies
authors.affiliation: Department of Primary Care and Public Health, School of Public Health, Imperial College London, London, UK.
authors.forename: Kausik K
authors.initials: KK
authors.lastname: Ray
authors.affiliation: Department of Health Sciences, University of Leicester, Leicester, UK.
authors.forename: Laura
authors.initials: L
authors.lastname: Gray
authors.affiliation: Diabetes Research Centre, University of Leicester, Leicester, UK.|Leicester Clinical Trials Unit, Leicester Diabetes Centre, University of Leicester, Leicester, UK.|Lifestyle and Physical Activity Biomedical Research Unit, Leicester-Loughborough NIHR Diet, Leicester, UK.|NIHR Collaborations for Leadership in Applied Health Research and Care (CLAHRC), Leicester, UK.
authors.forename: Kamlesh
authors.initials: K
authors.lastname: Khunti
mesh_terms: D001499:Bayes Theorem; D016022:Case-Control Studies; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D006801:Humans; D009026:Mortality; D009203:Myocardial Infarction / Q000453:epidemiology* / Q000628:therapy; D009204:Myocardial Revascularization; D016016:Proportional Hazards Models
keywords: cardiovascular disease; diabetes complications; meta-analysis