A survey of drug treatment and outcomes in diabetic patients with acute myocardial infarcts.

Sixty-four diabetic patients suffering an acute myocardial infarct were retrospectively matched, by age, gender and smoking habit, to non-diabetic controls. The two groups were compared for cardiovascular risk factors, pre-admission and discharge drug treatment, in-hospital drug treatment, and complication and mortality rates. Hypertension was more prevalent in the diabetic (63%) than in the control (42%) group. When comparing drugs on admission to those at discharge, there was a significant increase in antiplatelet and nitrate usage in both groups (P < 0.001), in beta-blocker usage in the control group (P < 0.001) and in loop diuretic usage in the diabetic group (P < 0.001). The usage of angiotensin converting enzyme inhibitors was low: 16% of diabetic patients and 5% of controls at discharge. Thrombolytic therapy was used in 29 diabetics and 37 controls. There was a significantly higher complication rate in the diabetic group than in the control group (P < 0.006), the most common being congestive cardiac failure (59% vs 30%, P < 0.001). Four controls and 13 diabetic patients died; three of the latter had their diabetes diagnosed during the admission. This study did not clearly demonstrate any underlying risk factors or treatment variables to account for the increased morbidity or mortality in diabetic patients with acute myocardial infarct, when compared to a matched non-diabetic population. However, modest associations not detected by this relatively small study are still possible.