Acute Myocardial Infarction in Diabetic Patients in the Thrombolytic Era

Abstract

To examine the benefits of thrombolytic therapy in diabetic patients with acute myocardial infarction a retrospective study of all diabetic and non-diabetic patients with acute myocardial infarction admitted to the coronary care unit of the General Hospital, Birmingham between January 1984 and December 1987 was made and findings compared to corresponding groups admitted between January 1990 and May 1992 when thrombolytic therapy was routine. In-hospital mortality and morbidity were assessed in 208 diabetic and 1029 non-diabetic patients with acute myocardial infarction admitted 1984 and 1987 and in 115 diabetic and 501 non-diabetic patients with myocardial infarction between January 1990 and May 1992. Following the introduction of thrombolytic therapy, there was a reduction in mortality among non-diabetic patients from 17% to 8.5%; p < 0.001 (observed reduction: 49%; 95% CI: 30-70%) and in the incidence of left ventricular failure (from 22% to 8%, p < 0.1 (observed reduction: 52%; 95% CI: 40-85.5%). Diabetic patients showed a reduction in mortality from 30% to 17%; p = 0.02 (observed reduction: 42%; 95% CI: 9.4-73.8%) and in the incidence of left ventricular failure from 39% to 21%; p < 0.01 (observed reduction: 45%; 95% CI: 20.3-72.5%). Thrombolytic therapy confers a major benefit on diabetic patients with acute myocardial infarction, although this group remains at a prognostic disadvantage compared to non-diabetic patients.

A systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction

“…Table 1 shows the characteristics of the 110 included studies. Twelve studies [2,[7][8][9]39,63,72,73,93,100,103,106] reported N 1 cohort of patients which in this case were abstracted separately leading to 139 studies/cohorts for statistical analysis. The median inclusion year varied from 1970 to 2011, and the number of patients per study from 255 to 160,773.…”

Prognostic value of admission blood glucose concentration and diabetes diagnosis on survival after acute myocardial infarction: results from 4702 index cases in routine practice

“…The benefit of active lowering of blood glucose after AMI has been demonstrated in a number of studies [8][9][10]19], and greater falls in blood glucose in the period following admission with AMI is associated with better survival [16,18,19]. In both DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) studies, effective glucose lowering soon after AMI was associated with improved survival [16,17], and recently, prescription of insulin in patients with AMI, not previously known to have diabetes, is associated with improved outcome [20].…”

“…Similarly, studies assessing the association with prognosis of hyperglycaemia have, for the most part, considered blood glucose concentration as a dichotomized variable, using varying cut-off values [5,8,9]. Those studies considering blood glucose as a graded variable have been in selected cohorts, considering only patients with prior diabetes diagnosis [3,7,18] or aged >65 years [6], or used fasting glucose [9,10] or glycated haemoglobin [11].…”

Impact of Stress Hyperglycemia on Myocardial Salvage Following Successfully Recanalized Primary Acute Myocardial Infarction

“…Stress hyperglycemia was defined as blood glucose ≥10 mmol/L (180 mg/dl) on admission, as described previously. 10, 11 Patients with a previous or current diagnosis of diabetes or an abnormal oral glucose tolerance test (OGTT, 75-g) 5 days after admission were defined as having diabetes.…”