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Myocardial infarct size and mortality in diabetic patients
Insights
Diabetic patients have higher myocardial infarction mortality. This study found no evidence that diabetes causes larger heart damage, suggesting other factors influence survival rates in diabetic individuals.
Area of Science:
- Cardiology
- Endocrinology
- Biochemistry
Background:
- Diabetic patients exhibit a disproportionately high mortality rate following myocardial infarction.
- A potential explanation for this increased fatality is more extensive myocardial necrosis in diabetics.
Purpose of the Study:
- To investigate whether diabetic patients experience greater myocardial damage after myocardial infarction compared to non-diabetic patients.
- To determine if infarct size contributes to the higher mortality observed in diabetic individuals post-myocardial infarction.
Main Methods:
- Retrospective analysis of peak serum aspartate aminotransferase (AST) concentrations in myocardial infarction patients over 16 years.
- Retrospective comparison of peak AST concentrations in diabetic patients versus age- and sex-matched controls.
- Prospective investigation of creatine kinase MB (CK-MB) release and electrocardiographic measures of infarct size in a case/control study.
Main Results:
- While cardiac failure and mortality were higher in diabetic groups, no significant differences in estimated infarct size were found between diabetic and non-diabetic patients across all study parts.
- Peak serum AST concentrations did not differ significantly between diabetic and non-diabetic myocardial infarction patients.
- Creatine kinase MB release and electrocardiographic infarct size estimates showed no significant differences between diabetic and non-diabetic groups.
Conclusions:
- The increased case fatality rate in diabetic patients following myocardial infarction is not attributable to more extensive myocardial damage.
- Factors preceding the infarction likely influence the poorer survival outcomes observed in diabetic patients.
- Further research should explore pre-infarction factors impacting survival in diabetic individuals with myocardial infarction.
Abstract:
The mortality rate from myocardial infarction is disproportionately high in diabetic patients. One explanation for this may be that diabetic patients incur more extensive myocardial necrosis. This possibility was examined in a three part study. Firstly, peak serum aspartate aminotransferase concentrations of all diabetic and non-diabetic patients admitted with myocardial infarction over a 16 year period were compared retrospectively. Secondly, peak aspartate aminotransferase concentrations in a series of diabetic patients and controls matched by age and sex were examined retrospectively. Thirdly, creatine kinase MB release and electrocardiographic measures of infarct size were investigated prospectively in a case/control study. Although cardiac failure and death were more common in the diabetic groups, there were no significant differences in estimates of infarct size between diabetic and non-diabetic patients in any of the studies. Therefore, the high case fatality rate amongst diabetic patients is not caused by increased myocardial damage. Presumably survival is prejudiced by factors operating before the infarction.