Diabetes mellitus and acute coronary syndromes. Prognosis and risk factors

Abstract: Aims: the aims of the thesis were: - To investigate the prognostic influence of diabetes on short- and long-term mortality after an episode of unstable coronary disease - To evaluate the association between glycometabolic parameters on admission and during hospitalization and the 2 year mortality risk among diabetic patients with unstable coronary disease - To investigate the influence of diabetes on treatment and outcome in patients with acute myocardial infarction (AMI) - To determine long-term morbidity and mortality after hospitalization for unstable coronary disease in patients with and without diabetes Diabetes was associated with higher mortality: We investigated an unselected series of 4,341 patients with unstable angina or non-Q-wave myocardial infarction, of which 722 (17%) had diabetes. Diabetes was associated with increased mortality during initial hospitalization (10.2% vs 5.7%, p<0.0001), after 30 days (13% vs 7.5%, p<0.0001), and at 2 years (33.7% vs 20.2%, p<0.0001). A history of diabetes was an independent risk factor associated with mortality in short- and long-term follow–up. Association between hyper- and hypoglycaemia and 2 year all-cause mortality risk in diabetic patients with unstable coronary disease: The relationship between hyperglycaemia on admission, hypoglycaemia during hospitalization and mortality was determined among 713 diabetic patients. Hyperglycaemia on admission and hypoglycaemia during hospitalization were independently associated with worse adjusted 2 year mortality risk among diabetic patients with unstable coronary disease. A history of diabetes was associated with a nearly two-fold higher mortality: The study included 3,824 hospitalized patients with a diagnosis of acute myocardial infarction, of whom 734 (19%) had diabetes. The patients, who came from two different countries Sweden (Göteborg) and the United States (Minneapolis-St. Paul, Minnesota) were hospitalized during two separate periods of time. A history of diabetes was associated with a nearly two-fold higher long-term mortality rate and was independently associated with seven-year mortality following AMI. A lower rate of evidence-based treatment was observed in patients with diabetes and may have contributed to the worse clinical outcome. Short- and long-term mortality decreased between 1990 and 1995 in both non-diabetic and diabetic patients. Diabetes was an independent risk factor for long-term morbidity: The study included 6,676 consecutive patients, who had a discharge diagnosis of unstable angina or acute myocardial infarction in the period 1987-1999. The study included 1,058 (15.8%) patients with previously diagnosed diabetes mellitus. Diabetes was an independent risk factor for long-term morbidity after hospitalization for unstable coronary disease. Diabetes mellitus remained an independent predictor of 5-year all-cause mortality, or hospitalization for AMI, or stroke, or congestive heart failure. Summary: Diabetes was an independent risk factor for short- and long-term morbidity as well as mortality after hospitalization due to unstable coronary disease. Hyperglycaemia on admission and hypoglycaemia during hospitalization are both associated with a higher mortality risk in diabetic patients with unstable coronary disease.