Circulation. 1998;97:12-15
(Circulation. 1998;97:12-15.)
© 1998 American Heart Association, Inc.
Acute Myocardial Infarction in Diabetes Mellitus
Lessons Learned From ACE Inhibition
Richard W. Nesto, MD;
; Stuart Zarich, MD
From the Cardiovascular Division, Beth Israel Deaconess Medical Center,
Harvard Medical School, Boston, Mass (R.W.N.) and the Cardiovascular Division,
Bridgeport Hospital, Yale University Medical School, Bridgeport, Conn (S.Z.).
Correspondence to Richard W. Nesto, MD, 110 Francis St, Suite 4B, Boston, MA 02215. E-mail rnesto@west.bidmc.harvard.edu
Key Words: diabetes mellitus • myocardial infarction
Diabetes mellitus
affects 
6% of the US population but is present in as many as
30% of patients hospitalized with acute coronary syndromes. It
has been recognized for some time that diabetics experience a greater
mortality during the acute phase of myocardial infarction (MI) and a
higher morbidity in the postinfarction period (see recent reviews in
References 1 and 21 2 ). Before the advent of coronary care as we
know it today, mortality among diabetic patients in MI was reported to
be as high as 40%3 and at least double the
mortality rate in patients without diabetes. More extensive
coronary artery disease, additional
cardiovascular risk factors, and other end-organ
disease were thought to be largely responsible for this major
difference in outcome. Current treatment of acute MI derived from large
clinical trials has dramatically improved survival in both nondiabetic
and diabetic patients. However, despite these improvements, diabetes
still doubles the case-fatality rate. In the GUSTO-1 angiography
substudy report,4 this twofold increase in
relative risk of 30-day mortality persisted even after adjustment for
the factors cited above. What is this "diabetic factor"? It is in
this context that new information on this topic must be evaluated.
In the December 16, 1997, issue of Circulation, the GISSI-3
investigators compare the effect of early administration (within 24
hours of admission) of lisinopril in patients with and
without diabetes mellitus in MI.5 Compared with
placebo, lisinopril dramatically reduced both 6-week and
6-month mortality in diabetics versus nondiabetics (6 weeks, 30%
versus 5% and . . . [Full Text of this Article]
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