Long-term prognosis of diabetic patients with acute myocardial infarction in the era of acute revascularization

Cardiovascular Diabetology

Original Investigation

Ryo Koyanagi¹  Tsuyoshi Shiga¹  Hiroshi Kasanuki¹  Hiroshi Ogawa¹  Jun-ichi Yamaguchi¹  Nobuhisa Hagiwara¹  Atsushi Takagi¹  Fumiaki Mori¹  Ayako Takara²  Yasuhiro Endoh² 

[1] Department of Cardiology, the Heart Institute of Japan, Tokyo Women's Medical University, Tokyo, Japan;Division of Cardiology, Saiseikai Kurihashi Hospital, Saitama, Japan;

关键词: Diabetic Patient;    Percutaneous Coronary Intervention;    Coronary Artery Bypass Grafting;    Propensity Score;    Acute Myocardial Infarction;   

DOI  :  10.1186/1475-2840-9-1

 received in 2009-10-25, accepted in 2010-01-04,  发布年份 2010

来源: Springer

【 摘 要 】

BackgroundThe long-term prognosis of diabetic patients with acute myocardial infarction (AMI) treated by acute revascularization is uncertain, and the optimal pharmacotherapy for such cases has not been fully evaluated.MethodsTo elucidate the long-term prognosis and prognostic factors in diabetic patients with AMI, a prospective, cohort study involving 3021 consecutive AMI patients was conducted. All patients discharged alive from hospital were followed to monitor their prognosis every year. The primary endpoint of the study was all-cause mortality, and the secondary endpoint was the occurrence of major cardiovascular events. To elucidate the effect of various factors on the long-term prognosis of AMI patients with diabetes, the patients were divided into two groups matched by propensity scores and analyzed retrospectively.ResultsDiabetes was diagnosed in 1102 patients (36.5%). During the index hospitalization, coronary angioplasty and coronary thrombolysis were performed in 58.1% and 16.3% of patients, respectively. In-hospital mortality of diabetic patients with AMI was comparable to that of non-diabetic AMI patients (9.2% and 9.3%, respectively). In total, 2736 patients (90.6%) were discharged alive and followed for a median of 4.2 years (follow-up rate, 96.0%). The long-term survival rate was worse in the diabetic group than in the non-diabetic group, but not significantly different (hazard ratio, 1.20 [0.97-1.49], p = 0.09). On the other hand, AMI patients with diabetes showed a significantly higher incidence of cardiovascular events than the non-diabetic group (1.40 [1.20-1.64], p < 0.0001). Multivariate analysis revealed that three factors were significantly associated with favorable late outcomes in diabetic AMI patients: acute revascularization (HR, 0.62); prescribing aspirin (HR, 0.27); and prescribing renin-angiotensin system (RAS) inhibitors (HR, 0.53). There was no significant correlation between late outcome and prescription of beta-blockers (HR, 0.97) or calcium channel blockers (HR, 1.27). Although standard Japanese-approved doses of statins were associated with favorable outcome in AMI patients with diabetes, this was not statistically significant (0.67 [0.39-1.06], p = 0.11).ConclusionsAlthough diabetic patients with AMI have more frequent adverse events than non-diabetic patients with AMI, the present results suggest that acute revascularization and standard therapy with aspirin and RAS inhibitors may improve their prognosis.

【 授权许可】

Unknown   
© Takara et al; licensee BioMed Central Ltd. 2010. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.