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Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.

Publication ,  Journal Article
Mak, KH; Moliterno, DJ; Granger, CB; Miller, DP; White, HD; Wilcox, RG; Califf, RM; Topol, EJ
Published in: J Am Coll Cardiol
July 1997

OBJECTIVES: This study was undertaken to define and better understand the characteristics and outcomes of patients with diabetes treated for acute myocardial infarction with contemporary thrombolysis. BACKGROUND: Although thrombolysis has substantially improved survival of patients with myocardial infarction, diabetes mellitus remains an independent predictor for a poor prognosis. METHODS: We characterized the contemporary relation between diabetes and outcome after myocardial infarction treated with thrombolytic agents from a large international cohort. Of 41,021 patients randomized to receive accelerated tissue-type plasminogen activator (t-PA), streptokinase or a combination of both agents in the Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries study, there were 5,944 patients with diabetes and 34,888 patients without diabetes. RESULTS: Patients with diabetes were older and more likely to be female, to present with anterior wall infarction, to receive thrombolysis later and to have triple-vessel coronary artery disease. Mortality at 30 days was highest among diabetic patients treated with insulin (12.5%) compared with non-insulin-treated diabetic (9.7%) and nondiabetic (6.2%) patients (p < 0.001). Mortality was lowest among those with diabetes receiving accelerated t-PA, which is consistent with the results of the overall patient cohort. Although stroke occurred more frequently among diabetic (1.9%) than nondiabetic patients (1.4%, p < 0.001), there was no significant difference in the rates of intracranial hemorrhage. Cardiac failure, shock, atrioventricular block and atrial flutter/ fibrillation were more common among diabetic patients. The proportion of patients undergoing revascularization was similar between patients with and without diabetes, although diabetic patients were more likely to undergo coronary artery bypass graft surgery (10.4% vs. 8.3%). Diabetes remained an independent predictor for mortality at 1-year follow-up (14.5% vs. 8.9%, p < 0.001). CONCLUSIONS: Diabetes, alone and in association with its comorbidities, portends a substantially worse 30-day and 1-year prognosis for patients with myocardial infarction.

Duke Scholars

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Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

July 1997

Volume

30

Issue

1

Start / End Page

171 / 179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Streptokinase
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Plasminogen Activators
  • Odds Ratio
  • Myocardial Infarction
 

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Mak, K. H., Moliterno, D. J., Granger, C. B., Miller, D. P., White, H. D., Wilcox, R. G., … Topol, E. J. (1997). Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol, 30(1), 171–179. https://doi.org/10.1016/s0735-1097(97)00118-6
Mak, K. H., D. J. Moliterno, C. B. Granger, D. P. Miller, H. D. White, R. G. Wilcox, R. M. Califf, and E. J. Topol. “Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries.J Am Coll Cardiol 30, no. 1 (July 1997): 171–79. https://doi.org/10.1016/s0735-1097(97)00118-6.
Journal cover image

Published In

J Am Coll Cardiol

DOI

ISSN

0735-1097

Publication Date

July 1997

Volume

30

Issue

1

Start / End Page

171 / 179

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Tissue Plasminogen Activator
  • Thrombolytic Therapy
  • Streptokinase
  • Prospective Studies
  • Prognosis
  • Predictive Value of Tests
  • Plasminogen Activators
  • Odds Ratio
  • Myocardial Infarction