(Circulation. 2000;102:1014.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
Impact of Diabetes on Long-Term Prognosis in Patients With Unstable Angina and Non–Q-Wave Myocardial Infarction
Results of the OASIS (Organization to Assess Strategies for Ischemic Syndromes) Registry
From the Department of Cardiology, Karolinska Hospital, Stockholm, Sweden (K.M.); the Preventive Cardiology and Therapeutics Program (S.Y., J.B., F.Z.) and Division of Endocrinology and Metabolism (H.C.G.), McMaster University, Hamilton, Canada; Royal Melbourne Hospital, Melbourne, Australia (D.H.); Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (L.P.); Rush-Presbyterian St. Luke’s Medical Center, Chicago, Ill (J.C.); Hungary Institute of Cardiology, Budapest, Hungary (M.K.); and Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.).
Background—Although unstable coronary artery disease is the most common reason for admission to a coronary care unit, the long-term prognosis of patients with this diagnosis is unknown. This is particularly true for patients with diabetes mellitus, who are known to have a high morbidity and mortality after an acute myocardial infarction.
Methods and Results—Prospectively collected data from 6 different countries in the Organization to Assess Strategies for Ischemic Syndromes (OASIS) registry were analyzed to determine the 2-year prognosis of diabetic and nondiabetic patients who were hospitalized with unstable angina or non–Q-wave myocardial infarction. Overall, 1718 of 8013 registry patients (21%) had diabetes. Diabetic patients had a higher rate of coronary bypass surgery than nondiabetic patients (23% versus 20%, P<0.001) but had similar rates of catheterization and angioplasty. Diabetes independently predicted mortality (relative risk [RR], 1.57; 95% CI, 1.38 to 1.81; P<0.001), as well as cardiovascular death, new myocardial infarction, stroke, and new congestive heart failure. Moreover, compared with their nondiabetic counterparts, women had a significantly higher risk than men (RR, 1.98; 95% CI, 1.60 to 2.44; and RR, 1.28; 95% CI, 1.06 to 1.56, respectively). Interestingly, diabetic patients without prior cardiovascular disease had the same event rates for all outcomes as nondiabetic patients with previous vascular disease.
Conclusions—Hospitalization for unstable angina or non–Q-wave myocardial infarction predicts a high 2-year morbidity and mortality; this is especially evident for patients with diabetes. Diabetic patients with no previous cardiovascular disease have the same long-term morbidity and mortality as nondiabetic patients with established cardiovascular disease after hospitalization for unstable coronary artery disease.
Key Words: diabetes mellitus • angina • myocardial infarction • prognosis
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F. A. McAlister, J. Man, L. Bistritz, H. Amad, and P. Tandon Diabetes and Coronary Artery Bypass Surgery: An examination of perioperative glycemic control and outcomes Diabetes Care, May 1, 2003; 26(5): 1518 - 1524. [Abstract] [Full Text] [PDF]
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M. W. Massing, K. A. Foley, C. A. Sueta, M. Chowdhury, D. P. Biggs, C. M. Alexander, and R. J. Simpson Jr. Trends in Lipid Management Among Patients With Coronary Artery Disease: Has diabetes received the attention it deserves? Diabetes Care, April 1, 2003; 26(4): 991 - 997. [Abstract] [Full Text] [PDF]
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L. E. Eberly, J. D. Cohen, R. Prineas, and L. Yang Impact of Incident Diabetes and Incident Nonfatal Cardiovascular Disease on 18-Year Mortality: The Multiple Risk Factor Intervention Trial experience Diabetes Care, March 1, 2003; 26(3): 848 - 854. [Abstract] [Full Text] [PDF]
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P. Ballinger Do all diabetic patients need statins? A view from primary care The British Journal of Diabetes & Vascular Disease, January 1, 2003; 3(1): 58 - 61. [Abstract] [PDF]
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References Circulation, December 17, 2002; 106(25): 3373 - 3421. [Full Text]
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N. N. Wahab, E. A. Cowden, N. J. Pearce, M. J. Gardner, H. Merry, J. L. Cox, and ICONS Investigators Is blood glucose an independent predictor of mortality in acute myocardial infarction in the thrombolytic era? J. Am. Coll. Cardiol., November 20, 2002; 40(10): 1748 - 1754. [Abstract] [Full Text] [PDF]
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L. Ryden and K. Malmberg Who are the enemies? Diabetes mellitus -- a major risk factor for ischaemic myocardial injury: new directions in the management of acute coronary syndromes in the diabetic patient Eur. Heart J. Suppl., November 1, 2002; 4(suppl_G): G21 - G25. [Abstract] [PDF]
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T. Y. Goraya, C. L. Leibson, P. J. Palumbo, S. A. Weston, J. M. Killian, E. A. Pfeifer, S. J. Jacobsen, R. L. Frye, and V.e. L. Roger Coronary atherosclerosis in diabetes mellitus: A population-based autopsy study J. Am. Coll. Cardiol., September 4, 2002; 40(5): 946 - 953. [Abstract] [Full Text] [PDF]
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S. M. Haffner and R. B. Goldberg New Strategies for the Treatment of Diabetic Dyslipidemia Diabetes Care, July 1, 2002; 25(7): 1237 - 1239. [Full Text] [PDF]
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J. A. Beckman, M. A. Creager, and P. Libby Diabetes and Atherosclerosis: Epidemiology, Pathophysiology, and Management JAMA, May 15, 2002; 287(19): 2570 - 2581. [Abstract] [Full Text] [PDF]
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F. J. Th. Wackers and B. L. Zaret Detection of Myocardial Ischemia in Patients With Diabetes Mellitus Circulation, January 1, 2002; 105(1): 5 - 7. [Full Text] [PDF]
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M. Roffi, D. P. Chew, D. Mukherjee, D. L. Bhatt, J. A. White, C. Heeschen, C. W. Hamm, D. J. Moliterno, R. M. Califf, H. D. White, et al. Platelet Glycoprotein IIb/IIIa Inhibitors Reduce Mortality in Diabetic Patients With Non-ST-Segment-Elevation Acute Coronary Syndromes Circulation, December 4, 2001; 104(23): 2767 - 2771. [Abstract] [Full Text] [PDF]
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K. J. Mukamal, R. W. Nesto, M. C. Cohen, J. E. Muller, M. Maclure, J. B. Sherwood, and M. A. Mittleman Impact of Diabetes on Long-Term Survival After Acute Myocardial Infarction: Comparability of risk with prior myocardial infarction Diabetes Care, August 1, 2001; 24(8): 1422 - 1427. [Abstract] [Full Text] [PDF]
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F. B. Hu, M. J. Stampfer, C. G. Solomon, S. Liu, W. C. Willett, F. E. Speizer, D. M. Nathan, and J. E. Manson The Impact of Diabetes Mellitus on Mortality From All Causes and Coronary Heart Disease in Women: 20 Years of Follow-up Arch Intern Med, July 23, 2001; 161(14): 1717 - 1723. [Abstract] [Full Text] [PDF]
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I. Gustafsson and P. Hildebrandt Blood glucose in the CCU: time to measure Eur. Heart J., July 1, 2001; 22(13): 1061 - 1062. [PDF]
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G. A. Beller Coronary Heart Disease in the First 30 Years of the 21st Century: Challenges and Opportunities : The 33rd Annual James B. Herrick Lecture of the Council on Clinical Cardiology of the American Heart Association Circulation, May 22, 2001; 103(20): 2428 - 2435. [Full Text] [PDF]
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