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(Circulation. 2000;102:1014.)
© 2000 American Heart Association, Inc.
Clinical Investigation and Reports |
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. Lukes Medical Center, Chicago, Ill (J.C.); Hungary Institute of Cardiology, Budapest, Hungary (M.K.); and Postgraduate Medical School, Grochowski Hospital, Warsaw, Poland (A.B.).
BackgroundAlthough 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 ResultsProspectively 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 nonQ-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.
ConclusionsHospitalization for unstable angina or nonQ-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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