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Gains in last decade: big mortality reduction seen in diabetic patients with MI.

NEW ORLEANS -- In-hospital mortality among acute MI patients with diabetes has declined sharply during the past decade, with diabetic women leading the way, Dr. Darren K. McGuire said at the annual meeting of the American College of Cardiology.

In 1994, diabetic patients with acute MI were 25% more likely to die while hospitalized than nondiabetic MI patients. But by 2002, diabetic patients were only 14% more likely to die while hospitalized than nondiabetics, according to an analysis of more than 1.4 million consecutive acute MIs treated in U.S. hospitals during this time frame.

"This is almost a 50% reduction in the increment of risk associated with diabetes. To our knowledge, this is the first study that's made this observation," commented Dr. McGuire of the University of Texas, Dallas.

The most impressive survival gains were observed in diabetic women. Women with diabetes who experienced an MI in 2002 were 44.5% less likely to die while hospitalized than were diabetic women with an MI in 1994.

Diabetic men with MI experienced an adjusted 30.2% decline in in-hospital mortality during the same time period. In nondiabetic men, the reduction was 23.5%, while nondiabetic women had a 34.2% decrease.

Overall, nondiabetic acute MI patients had an adjusted 20.1% decline in in-hospital mortality during 1994-2002. Patients with diabetes had a 38% reduction, according to the analysis of National Registry of Myocardial Infarction (NRMI) data on 1,428,596 consecutive acute MI patients.

Credit for this improvement most likely goes to the increasingly diligent use physicians have made of evidence-based therapies for MI, as has been documented in NRMI data.

Diabetic patients, despite their high-risk status, have historically been less likely to receive evidence-based acute MI therapies including [beta]-blockers, ACE inhibitors, thrombolytics, and primary percutaneous intervention.

That's changing. Indeed, it's probably no coincidence that the greatest increase in use of evidence-based treatments during the past decade was observed in diabetic female NRMI enrollees--the group who had the largest mortality reduction, Dr. McGuire noted.

NRMI's good news regarding improved MI survival in diabetic patients was partially offset by some unwelcome news: In 1994, one in four patients hospitalized with acute MI was diabetic, but by 2002 that figure had climbed to 30.8%, a 20.8% jump.

NRMI is funded by Genentech Inc. A caveat is that the NRMI data reflect only the experience of the roughly one-quarter of U.S. acute care hospitals participating in the registry. The observed trends may not apply to other hospitals.


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Title Annotation:Cardiovascular Medicine
Author:Jancin, Bruce
Publication:Internal Medicine News
Date:Apr 15, 2004
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