Diabetes is an independent predictor of survival 17 years after myocardial infarction: follow-up of the TRACE registry.

BACKGROUND

In patients hospitalized for myocardial infarction, there are limited data examining the long-term prognostic effect of diabetes. The aim of this study was to systematically evaluate the development of diabetes as an independent long-term prognostic factor after myocardial infarction.

METHODS

Prospective follow-up of 6676 consecutive MI patients screened for entry in the Trandolapril Cardiac Evaluation (TRACE) study. The patients were analysed by Kaplan-Meier survival analysis, landmark analysis and Cox proportional hazard models and outcome measure was all-cause mortality.

RESULTS

The mortality in patients with diabetes was 82,7% at 10 years of follow-up and 91,1% at 15 years of follow-up, while patients without diabetes had a mortality of 60,2% at 10 years of follow-up and 72,9% at 15 years of follow-up (p < 0.0001). Landmark analysis continued to show prognostic significance of diabetes throughout the duration of follow-up. Multivariable Cox proportional-hazards model showed that the hazard ratio for death in patients with diabetes overall was 1.47 (95% confidence intervals (CI) 1.35-1.61) and varied between 1.19 (CI 1.04-1.37) and 2.13 (CI 1.33-3.42) in the 2-year periods of follow-up.

CONCLUSIONS

Diabetes is an important independent long-term prognostic factor after MI and continues to predict mortality even 17 years after index MI. This underscores the importance of aggressive diagnostic and therapeutic approach in diabetes patients with MI.