Management and short-term outcome of diabetic patients hospitalized for acute myocardial infarction: results of a nationwide French survey

Objectives: To compare management and short-term outcome of diabetic and non-diabetic patients hospitalized for acute myocardial infarction. Methods: This was a prospective epidemiological survey. All patients admitted in coronary care units in France in November 2000 for confirmed acute myocardial infarction were eligible to enter the study. Results: Of the 2320 patients recruited from 369 centers, 487 were diabetic (21%). Compared to non-diabetic patients, diabetic patients were 5 years older, more often female, obese and hypertensive; they had more often a history of cardiovascular disease; they had a lower ejection fraction and worse Killip class. Reperfusion therapy was less frequent among diabetic patients (39% versus 51%; p = 0.0001), as was the use of beta-blockers (61% versus 72%; p = 0.0001), aspirin (83% versus 89%; p = 0.0001) and statins (52% versus 60%; p = 0.001) during hospitalization. Conversely, the use of ACE-inhibitors was more frequent (54% versus 44%; p = 0.0001). 58% of diabetic patients received insulin during hospitalization. Twenty-eight-day mortality was 13.1% in diabetic patients and 7.0% in non-diabetic patients (risk ratio: 1.87; p = 0.001). Diabetes remained associated with increased mortality after adjustment for relevant risk factors including age and ejection fraction (risk ratio: 1.51; p = 0.07). In patients treated with antidiabetic drugs (chiefly sulfonylureas) before admission, 28-day mortality was 10.4% compared with 19.9% in diabetic patients on diet alone or untreated (p = 0.005). Conclusion: Despite higher cardiovascular risk and worse prognosis, in-hospital management of diabetic patients with acute myocardial infarction remains sub-optimal. Patients previously treated with antidiabetic drugs including sulfonylureas had a better prognosis an untreated diabetic patients.