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(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

Klas Malmberg, MD, PhD; Salim Yusuf, MBBS, DPhil; Hertzel C. Gerstein, MD, MSc; Joanne Brown, BSc; Feng Zhao, MSc; David Hunt, MD; Leopoldo Piegas, MD; James Calvin, MD; Matyas Keltai, MD; Andrzej Budaj, MD; for the OASIS Registry Investigators

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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