[Differences of the clinical course and prognosis in diabetics with myocardial infarction]

Diabetes mellitus (DM) is one of the most potent risk factor of in-hospital and long-term prognosis after myocardial infarction (MI). The study aim was to compare in-hospital management and long-term prognosis in diabetics with acute transmural MI especially in the aspect of thrombolytic therapy. We analyzed 881 patients with acute MI treated in our hospital in 1992-1996. DM was found in 21.5% of all studied patients. Data based on past history, management of in-hospital course and next ambulatory control exams in the period 2-6 years were performed using statistical methods and then compared together. Diabetics had significant more often risk factor of development of coronary artery disease. Thrombolytic therapy had received 18.0% of diabetics and 22.1% nondiabetic patients in the age under 80 years-old. Thrombolytic therapy performed at patients with DM significantly reduced in-hospital mortality.

1. Diabetics had worse in-hospital course of acute MI because of more frequent hemodynamic complications. The overall incidence of arrhythmia and A-V conduction disturbances did not differ from nondiabetics. 2. In-hospital mortality in all patients with DM was twofold higher than in the rest (22.2% vs 11.0% p < 0.001). Mortality among patients with thrombolytic therapy did not significantly differ between the ones (5.9% vs 6.7%). 3. Mortality rate after MI in diabetics is 1.66 times higher to compare to nondiabetic.