Effect of diabetes on the course of acute myocardial infarction in Malta.

Among 1,118 admissions for acute ischemic heart disease to St. Luke's Hospital in Malta during 1963-72, there were 945 (84.5%) cases of acute myocardial infarction (AMI) and 173 (15.5%) cases of acute coronary insufficiency (ACI). The ratio of AMI to ACI was higher among diabetic than among nondiabetic patients, especially among women. In comparison with the nondiabetic AMI patients, the diabetics, especially women, had a significantly longer interval between onset of symptoms and hospitalization and more often had painless infarcts, both of which resulted in delay of adequate treatment; the diabetics with AMI han more complications and a significantly higher case fatality rate (20.8vs. 14.3% for nondiabetics; in diabetic women the rate was 24.1%). in fatal cases of AMI the mean age at death was lower among diabetics than among nondiabetics. In fatal cases among diabetics death was more often associated with an anteroseptal AMI site, and was the result of one or more of the following: left heart failure (61.6%), shock (38.3%), sudden death from ventricular fibrillation (13.3%), atrioventricular block (8.3%), or systemic or pulmonary arterial thromboembolism (6.5%); it was very rarely the result of diabetic ketosis.