Short- and Long-Term Mortality After Myocardial Infarction in Patients With and Without Diabetes: Changes from 1985 to 2008

OBJECTIVE: To study temporal trends in short- and long-term outcome after myocardial infarction (MI) according to diabetes status. RESEARCH DESIGN AND METHODS: We included all 14,434 consecutive patients admitted for ST-segment elevation MI or non–ST-segment elevation MI at our center between 1985 and 2008. The study patients were compared according to prevalent diabetes. Temporal trend analyses were performed by comparing decades of admission (1985–1989 vs. 1990–1999 vs. 2000–2008). RESULTS: A total of 2,015 (14%) of the patients had prevalent diabetes. The risk of presenting with diabetes increased from 8 to 17% from 1985 to 2008. Diabetic patients presented with a higher prevalence of cardiovascular risk factors. With time, the use of evidence-based therapies increased in both patients with and without diabetes. Diabetes is associated with a 1.5-fold increased risk of mortality at the 20-year follow-up. Ten-year mortality decreased over time in patients with diabetes, from 53% in 1985–1989 to 39% in 2000–2008 (adjusted hazard ratio 0.56 [95% CI 0.43–0.73]), and in those without diabetes, from 38% in 1985–1989 to 29% in 2000–2008 (0.66 [0.60–0.73]; P interaction = 0.83). Patients with diabetes benefitted from a higher 30-day and 10-year absolute survival increase. CONCLUSIONS: Temporal mortality reductions after MI between 1985 and 2008 were at least as high in patients with diabetes compared with those without diabetes. However, long-term mortality remained higher in diabetic patients. Awareness of the high-risk profile of diabetic patients is warranted and might stimulate optimal medical care and outcome.