Prognosis following first acute myocardial infarction in Type 2 diabetes: a comparative population study

被引:45
作者
Donnan, PT
Boyle, DIR
Broomhall, J
Hunter, K
MacDonald, TM
Newton, RW
Morris, AD [1 ]
机构
[1] Univ Dundee, Ninewells Hosp & Med Sch, DARTS MEMO Collaborat, Dept Clin Pharmacol, Dundee DD1 9SY, Scotland
[2] Univ Dundee, Ninewells Hosp & Med Sch, Univ Dept Med, Dundee DD1 9SY, Scotland
关键词
Type; 2; diabetes; mortality; MI; population;
D O I
10.1046/j.1464-5491.2002.00711.x
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Aims To estimate the incidence of death and macrovascular complications after a first myocardial infarction for patients with Type 2 diabetes. Research design In a retrospective, incidence cohort study in the Tayside Region of Scotland we studied all patients hospitalized with a diagnosis of first acute myocardial infarction from 1 April 1993 to 31 December 1994. The primary endpoint was time to death. Secondary endpoints were 2-year incidence of hospital admission for angina, myocardial infarction, stroke, heart failure, coronary angiography, coronary artery bypass graft (CABG) and percutaneous transluminal coronary angioplasty (PTCA). Results The 147 patients with Type 2 diabetes had significantly worse survival with an increase in relative hazard of 67% compared with non-diabetic patients. After adjustment for age, sex, smoking status, prior heart failure, prior angina, delay to hospitalization, site of infarction, drug therapy with aspirin, beta-blockers, streptokinase and hyperlipidaemia and treated hypertension, Type 2 diabetes was still associated with a 40% higher death rate compared with people without diabetes (P < 0.05) There was no significant difference in death rates in those aged over 70 years, but an indication of a trend in younger individuals with a four-fold increase in death rate in those with diabetes aged < 60 years, compared with a rate ratio of 2.6 in those with diabetes aged 61-70 years. Conclusions Among hospitalized patients with first acute myocardial infarction, Type 2 diabetes mellitus is consistently associated with increased mortality and increased hospital admission for heart failure. The estimated 4-year survival rate is only 50%. Our results indicate that younger subjects with Type 2 diabetes and acute myocardial infarction are a high-risk group deserving of special study, and support the argument for aggressive targeting of coronary risk factors among patients with Type 2 diabetes.
引用
收藏
页码:448 / 455
页数:8
相关论文
共 24 条
[1]   THE IMPACT OF DIABETES ON SURVIVAL FOLLOWING MYOCARDIAL-INFARCTION IN MEN VS WOMEN [J].
ABBOTT, RD ;
DONAHUE, RP ;
KANNEL, WB ;
WILSON, PWF .
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION, 1988, 260 (23) :3456-3460
[2]  
[Anonymous], 1990, Diabet Med, V7, P360
[3]   A British cardiac society survey of the potential for the secondary prevention of coronary disease: ASPIRE (Action on Secondary Prevention through Intervention to Reduce Events) - Principal results [J].
Bowker, TJ ;
Clayton, TC ;
Ingham, J ;
McLennan, NR ;
Hobson, HL ;
Pyke, SDM ;
Schofield, B ;
Wood, DA .
HEART, 1996, 75 (04) :334-342
[4]   The clinical implications of diabetic heart disease [J].
Butler, R ;
MacDonald, TM ;
Struthers, AD ;
Morris, AD .
EUROPEAN HEART JOURNAL, 1998, 19 (11) :1617-1627
[5]  
Evans J. M. M., 1995, Pharmaceutical Medicine (London), V9, P177
[6]  
Evans JMM, 1997, PHARMACOEPIDEM DR S, V6, P313
[7]   FACTORS THAT INFLUENCE OUTCOME IN DIABETIC SUBJECTS WITH MYOCARDIAL-INFARCTION [J].
FAVA, S ;
AZZOPARDI, J ;
MUSCAT, HA ;
FENECH, FF .
DIABETES CARE, 1993, 16 (12) :1615-1618
[8]  
IVENSTAM G, 1985, DIABETES, V34, P787
[9]  
KOONHOU MAK, 1997, J AM COLL CARDIOL, V30, P171
[10]   MYOCARDIAL INFARCT SIZE AND MORTALITY IN PATIENTS WITH NONINSULIN-DEPENDENT DIABETES-MELLITUS [J].
LEHTO, S ;
PYORALA, K ;
MIETTINEN, H ;
RONNEMAA, T ;
PALOMAKI, P ;
TUOMILEHTO, J ;
LAAKSO, M .
JOURNAL OF INTERNAL MEDICINE, 1994, 236 (03) :291-297