Author + information
- Received April 8, 1993
- Revision received July 8, 1993
- Accepted July 23, 1993
- Published online December 1, 1993.
- Giulio Zuanetti, MD∗,1,
- Roberto Latini, MD,
- Aldo P. Maggioni, MD,
- Luigi Santoro, BS2,
- Maria Grazia Franzosi,
- GISSI-2 Investigators∗
- ↵∗Address for correspondence: Dr. Giulio Zuanetti, Istituto Mario Negri, via Eritrea, 62, 20157 Milan, Italy.
Objectives. This study was conducted to determine the role of insulin-dependent and noninsulin-dependent diabetes in the prognosis of patients after myocardial infarction and treatment with fibrinolytic agents.
Background. Several studies have shown that diabetic patients have a high mortality rate after acute myocardial infarction. However, the impact of diabetes on survival in patients treated with fibrinolytic agents is still undefined. It is also not known whether the type of diabetes or gender affects prognosis.
Methods. We analyzed prevalence and prognostic significance of a history of diabetes in patients enrolled in the GISSI-2 study, all of whom received fibrinolytic agents. The incidence of deaths in the hospital and at 6 months after study entry was computed for patients without diabetes and for insulin-dependent and noninsulin-dependent diabetic patients; relative risks were evaluated by univariate and multivariate analysis.
Results. Information on diabetic status was available for 11,667 patients, 94.2% of those randomized in the GISSI-2 study. The prevalence of diabetes was higher in women than in men (8.75% vs. 1.85%, p < 0.01 for insulin-dependent and 23.7% vs. 13.8%, p < 0.01 for noninsulin-dependent diabetic patients). The type of fibrinolytic agent did not affect mortality rates; the increase in in-hospital mortality of diabetic patients was moderate and similar for men with insulin- and noninsulin-dependent diabetes (8.7% and 10.1%, respectively, vs. 5.8% in nondiabetic patients); in women, mortality was markedly higher for insulin-dependent and only slightly higher for noninsulin-dependent diabetic patients (24.0% and 15.8%, respectively, vs. 13.9% for nondiabetic patients). The adjusted relative risks were 1.9 (95% confidence interval 1.2 to 2.9) for insulin-dependent diabetic women and 1.4 (95% confidence interval 1.1 to 1.8) for noninsulin-dependent diabetic men. The mortality rate after discharge showed a similar gender difference, and in insulin-dependent diabetic women, prognosis was ominous even in the absence of left ventricular damage before discharge.
Conclusion. A history of diabetes is associated with a worse prognosis after myocardial infarction, even in patients treated with fibrinolytic agents. Gender and type of diabetes appear to be critical in affecting survival. In men, both insulin-dependent and noninsulin-dependent diabetes are associated with a moderately higher mortality rate; in women, insulin-dependent diabetes is, in itself, a strong risk factor for death after myocardial infarction.
↵1 Dr Zuanetti is a recipient of a “Maurelio Caniato” award fellowship.
↵2 Mr. Santoro is supported by a grant from Banca Popolare di Milano, Milan, Italy.
↵∗ A complete list of colaborators and prticipating centers appears in Reference Gruppo Italiano per lo Studio della Sopravvivenza nell'Infarto Miocardico, GISSI-2: a factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction. Lancet 1990;336:65-71.
☆ This stydy was supported in part by a research grant from Laboratori Guidotti, Pisa, Italy. The GISSI-2 was endorsed by the ANMCO (Associazione Nizionale Medici Cardiology Ospedalieri, Florence, Italy) and the Istituto di Ricerche Farmacologiche Mario Negri, Milan and was supported by a research grant from Boehringer Ingelheim, Florence.
- Received April 8, 1993.
- Revision received July 8, 1993.
- Accepted July 23, 1993.