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Aims To compare short-and long-term mortality after a first acute myocardial infarction (AMI) in patients with and without diabetes mellitus. Methods and results A nationwide cohort of 2,018 diabetic and 19,547 nondiabetic patients with a first hospitalized AMI in 1995 was identified through linkage of the national hospital discharge register and the population register. Follow-up for mortality lasted until the end of 2000. At 28 days and 5 years respectively, absolute mortality risks were 18 and 53% in diabetic men, 12 and 31% in nondiabetic men, 22 and 58% in diabetic women, and 19 and 42% in nondiabetic women. Crude mortality was significantly higher in diabetic patients than in nondiabetic patients in both men (28-day hazard ratio (HR) 1.55; 95% confidence interval (CI) 1.32-1.81, 5-year HR 2.01; 95% CI 1.84-2.21) and women (28-day HR 1.19; 95% CI 1.03-1.37, 5-year HR 1.53; 95% CI 1.40-1.67). After multivariate adjustment, risk differences became nonsignificant at 28 days, but diabetes was still associated with a significantly higher long-term mortality in both men (28-day HR 1.16; 95% CI 0.99-1.36, 5-year HR 1.49; 95% CI 1.36-1.64) and women (28-day HR 1.12; 95% CI 0.97-1.28, 5-year HR 1.39; 95% CI 1.27-1.52). The interaction between diabetes mellitus and gender did not reach significance in the analyses. Conclusion Our findings in an unselected cohort covering a complete nation show a significantly higher long-term mortality after a first acute myocardial infarction in diabetic patients. Yet, short-term mortality is not significantly higher in diabetic patients. Risks appear to be equally elevated in men and women.

PoM was not only delayed but also prolonged in preterm infants. Duration of PoM was associated with GA, birth weight and morphine therapy.

Objective: To study the change in incidence of hospitalisation for a first acute myocardial infarction (AMI) in the Netherlands from 1995 to 2000. Methods: Patients hospitalised with their first AMI in the Netherlands in 1995 and 2000 were identified through linkage of the national hospital discharge register and the population register. Results: 21 565 patients hospitalised for their first AMI in 1995 and 19 058 patients hospitalised for their first AMI in 2000 were identified. In both years, the age specific incidence of hospitalisation for a first AMI was higher in men than in women and increased with age (up to 90 years). In both men and women, the age standardised incidence was lower in 2000 than in 1995, a decline of 19% (95% confidence interval 17% to 21%) and 17% (95% confidence interval 14% to 19%), respectively. Conclusions: Our study provides the first nationwide incidence estimates of first AMI in the Netherlands. From 1995 to 2000, the risk of AMI declined considerably. M ortality from coronary heart disease (CHD) has declined during the past decades in many western countries.1 2 A decrease in CHD mortality is a consequence of a decrease in incidence, case fatality, or recurrence risk or a combination of these. Data from the World Health Organization MONICA (monitoring trends and determinants in cardiovascular disease) project, studying population samples from 21 countries, have suggested that in populations in which CHD mortality decreased, coronary event rates contributed two thirds and case fatality one third.3 Only a few countries provide nationwide data on the incidence of acute myocardial infarction (AMI). Many other countries, including the Netherlands, 4 have to rely on regional registries. However, after we recently showed that patients could validly be followed up within Dutch national (medical) registrations, 5 we set out to study the nationwide incidence of hospitalisation for first AMI, with emphasis on the change in incidence from 1995 to 2000. METHODS Data sourcesCases of first hospitalisation for AMI were identified by linkage of the Dutch national hospital discharge register with the Dutch population register. The hospital discharge register provides complete nationwide coverage of data on hospital admissions since 1986. For each admission, a principal diagnosis is determined at discharge by the treating physician and coded by local hospital staff according to the International classification of diseases, ninth revision, clinical modification (ICD-9-CM).6 A single institution is responsible for training hospital staff in coding. As the hospital discharge register does not contain a unique personal identifier, we tracked individual patients over time within the hospital discharge register by using information from the population register. The population register contains actual demographic information on all registered people living in the Netherlands. All analyses were performed in agreement with privacy legislation in the Netherlands at Statistics Netherlands. Data analysisThe inc...

See also Greco F, Porto I. Clinical usefulness of cardiac biomarkers in hemodynamically stable pulmonary embolism. This issue, pp 550-1.Summary. Background: Controversy exists about the indication of thrombolytic therapy in the subgroup of hemodynamically stable patients with acute pulmonary embolism (PE) and right ventricular dysfunction. Brain natriuretic peptide (BNP) is excreted from the cardiac ventricles in response to cardiomyocyte stretch and can be measured with an easy-to-perform blood test. Objective: The objective of this study was to determine the predictive value of elevated BNP levels for early recurrent venous thromboembolism with or without fatal outcome in hemodynamically stable patients with acute PE. In addition, we assessed the potential clinical consequences of initiating thrombolytic therapy based on the BNP levels alone. Methods: A nested case-control study was performed within the framework of a large randomized-controlled trial totalling 2213 hemodynamically stable patients with confirmed acute, symptomatic PE. Ninety patients experienced a fatal or non-fatal recurrent venous thromboembolism during the first 3 months of follow-up (cases); Two hundred and ninety-seven patients with uneventful follow-up served as controls. Blood for BNP levels was obtained at referral and assayed in a central laboratory. Results: Cases had significantly higher mean baseline BNP levels (P ¼ 0.0002). The odds ratio (OR) for every logarithmic (log) unit increase in BNP concentration was 2.4 (95% CI: 1.5-3.7). A BNP cut-off level of 1.25 pmol L )1[the optimal point on the receiver-operating characteristic (ROC) curve] was associated with a sensitivity and specificity of 60% and 62%, respectively. In theory, for every patient correctly receiving thrombolytic therapy at this cut-off, 16 patients will receive this therapy unnecessarily. Conclusions: Brain natriuretic peptide level at presentation is significantly associated with early (fatal) recurrent venous thromboembolism in hemodynamically stable patients with acute PE. However, this relationship appears clinically insufficient to guide the initiation of thrombolytic therapy.