Institute of Biometrics and Epidemiology, German Diabetes Centre, Leibniz-Centre for Diabetes Research, Heinrich-Heine-University, Düsseldorf, Germany,
Eur J Epidemiol. 2014 Dec;29(12):899-909. doi: 10.1007/s10654-014-9964-6. Epub 2014 Nov 1.
The aim of the study was to analyse mortality after a first myocardial infarction (MI) and its trends in people with diabetes compared to those without diabetes in Southern Germany, 1985-2009. Using data of the population-based MONICA/KORA Myocardial Infarction Registry, we ascertained all patients with a first fatal or non-fatal MI between 1985 and 2009 (n = 16,478, age 25-74 years, 71% male, 29% with diabetes). The impact of diabetes and calendar time on mortality was examined using multiple logistic and Cox regression. Survival improved with calendar time: The crude cumulative 5-year survival was 26.9 and 46.3% among diabetic and non-diabetic individuals (both sexes combined) with a first MI in the years 1985-1989, and 53.6 and 66.6% among those with a first MI in the years 2005-2009. This significant decrease of mortality was confirmed in multivariate analyses. The proportion of fatal first MIs was significantly higher in diabetic compared to non-diabetic patients [adjusted odds ratio (OR) 1.26; 95% confidence interval 1.17-1.36]. This association persisted in a similar manner between both sexes with no consistent change of OR over calendar time in which first MIs have been observed. Likewise, multiple adjusted risk of death after a non-fatal first MI was significantly higher among both diabetic men and women [hazard ratio (HR) 1.64; 1.47-1.82, 1.83; 1.55-2.14] with constant HR over calendar time. During the past 25 years, survival has improved in both diabetic and non-diabetic patients with incident MI in a similar manner. However, mortality after a first MI remained significantly higher in the diabetic population, particularly in women.
本研究旨在分析德国南部 1985 年至 2009 年间患有糖尿病与不患有糖尿病的人群首次心肌梗死（MI）后的死亡率及其变化趋势。我们利用基于人群的 MONICA/KORA 心肌梗死登记处的数据，确定了 1985 年至 2009 年间所有首次致命或非致命 MI 患者（n = 16478，年龄 25-74 岁，71%为男性，29%患有糖尿病）。使用多变量逻辑回归和 Cox 回归分析了糖尿病和时间对死亡率的影响。研究发现，随着时间的推移，生存率得到改善：在 1985-1989 年和 2005-2009 年期间患有首次 MI 的患者中，男女合计的糖尿病和非糖尿病患者的粗累积 5 年生存率分别为 26.9%和 46.3%以及 53.6%和 66.6%。这一死亡率显著下降在多变量分析中得到了证实。与非糖尿病患者相比，糖尿病患者首次致命性 MI 的比例明显更高[调整后的比值比（OR）1.26；95%置信区间 1.17-1.36]。这种关联在两性中均以相似的方式存在，并且在观察到首次 MI 的时间内，OR 没有一致变化。同样，在男性和女性糖尿病患者中，非致命性首次 MI 后死亡的风险比（HR）也显著更高[HR 1.64；1.47-1.82，1.83；1.55-2.14]，且 HR 随时间推移保持不变。在过去的 25 年中，患有 MI 的糖尿病和非糖尿病患者的生存率均得到了相似的提高。然而，糖尿病患者首次 MI 后的死亡率仍然显著更高，尤其是女性。
