Mortality After Acute Myocardial Infarction: Significance of Cardiovascular Diabetic Autonomic Neuropathy (CDAN)
Snezana Vujosevic, Miroslava Zamaklar, Natasa Belada, Sinisa Stamatovic
Med Arh. 2012; 66(5): 296-299
The aim of this study was to compare intrahospital and long-term mortalities after more than 10 years of the follow up after the first acute myocardial infarction (AMI) with patients with and without CDAN and without diabetes mellitus (DM). Methods: The study was based on 76 (43 men and 33 women) with DM type 2, CDAN was detected in 51 patients, and 374 (295 men and 79 women) without DM consecutively hospitalized with the first-ever AMI from January 1998. to December 2000. in Clinical Center of Montenegro Podgorica. Patients were followed until December 31. 2011. CDAN was searched for by standardized five tests evaluating heart rate and blood pressure variations. Results: Intrahospital mortality was presented in 10. 53 % diabetic patients and 5. 61 % nondiabetic patients, this difference is significant (p=0.048). Long-term mortality was presented at 24 (82. 75%) patients with CDAN and 5 (17. 25%) patients without CDAN (p=0.029). Long term mortality rate was significantly higher in diabetic patients 29 (42. 64 %) than in nondiabetic patients 102 (30. 72 %) (p=0.012). Conclusion: Intrahospital mortality was significantly higher in diabetic than in nondiabetic patients. Identically the mortality after more than 10 years of the follow up after the first AMI was significantly higher in diabetic with, than in diabetic patients without CDAN, as in diabetic than in nondiabetic patients.
1. Chun BY, Dobson AJ, Heller RF. The impact of diabetes on survival among patients with first myocardial infarction. Diabetes Care. 1997; 20: 704-708.
2. Miettinen H, Lehto S, Salomaa V. et al. Impact of diabetes on mortality after the first myocardial infarction. The FINMONICA myocardial infarction register study group. Diabetes Care. 1998; 21: 69-75.
3. Franklin K, Goldberg RJ, Spencer F. et al. GRACE investigators. Implications of diabetes in patients with acute coronary syndromes. The Gobal Registry of Acute Coronary Events. Arch Intern Med. 2004; 164: 1457-1463.
4. Timmer JR, OttervangerJP, Thomas K. et al. Zwolle myocardial infarction study group. Long-term, cause-specific mortality after myocardial infarction in diabetes. Eur Heart J. 2004; 25: 926-931.
5. Melchior T, Kober L, Madsen CR. et al. TRACE study group. Accelerating impact of diabetes mellitus on mortality in the years following an acute myocardial infarction. Eur Heart J. 1999; 20: 973-978.
6. Mukamal KJ, Nesto RW, Cohen MC. et al. Impact of diabetes on long-term survival after acute myocardial infarction. Comparability of risk with prior myocardial infarction. Diabetes Care. 2001; 24: 1422-1427.
7. Behar S, Boyko V, Reicher-Reiss H. et al. Ten-year survival after acute myocardial infarction: comparison of patients with and without diabetes. SPRINT study group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. Am Heart J. 1997; 133: 290-296.
8. Donnan PT, Boyle DI, Broomhall J. et al. Prognosis following first acute myocardial infarction in type 2 diabetes: a comparative population study. Diabet Med. 2002; 19: 48-55.
9. Koek HL, Soedamah-Muthu SS, Kardaun JWPF. et al. Short- and long-term mortality after acute myocardial infarction: comparison of patients with and without diabetes mellitus, Eur J Epidemiol. 2007; 22(12): 883-888.
10. Maser RE, Lenhard MJ. Cardiovascular autonomic neuropathy due to diabetes mellitus: clinical manifestations, consequences and treatment, The Journal of Clinical Endocrinology &Metabolism. 2005; 90(10): 5896-5903.
11. Miettinen H, Lehto S, Salomaa V. et al. Impact of diabetes on mortality after the first myocardial infarction: The FINMONICA Myocardial Infarction Register Study Group. Diabetes Care. 1998; 21: 69-75.
12. Ewing DJ, Martyn CN, Young RJ. et al. The value of cardiovascular autonomic function tests:10 years experience in diabetes. Diabetes Care. 1985; 8: 491-498.
13. Ewing DJ, Neilson JMM, Shapiro CM. et al. Twenty four hour heart rate variability: effects of posture, sleep and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients Br Heart J. 1991; 65: 239-244.
14. Valensi P, Sachs RN, Harfouche B. et al. Predictive value of cardiac autonomic neuropathy in diabetic patients with or without silent myocardial ischemia. Diabetes Care. 2001; 24: 339-343.
15. Milan Study on Atherosclerosis and Diabetes. (MiSAD) Group: prevalence of unrecognized silent myocardial ischemia and its association with atherosclerotic risk factors in noninsulin-dependent diabetes mellitus. Am J Cardiol. 1997; 79: 134-139.
16. The Diabetes Control and Complications Trial Research Group The effect of intensive diabetes therapy on measures of autonomic nervous system function in the Diabetes Control and Complications Trial (DCCT). Diabetologia. 1998; 41: 416-423.
17. Larsen JR, Sjoholm H, Berg TJ. et al. Eighteen years of fair glycemic control preserves cardiac autonomic function in type 1 diabetes. Diabetes Care. 2004; 27: 963-966.
18. Ohkubo Y, Kishikawa H, Araki E. et al. Intensive insulin therapy prevents the progression of diabetic microvascular complications in Japanese patients with non-insulin-dependent diabetes mellitus: a randomized prospective 6-year study. Diabetes Res Clin Pract. 1995; 28: 103-117.
19. Manzella D, Grella R, Esposito K. et al. Blood pressure and cardiac autonomic nervous system in obese type 2 diabetic patients: effect of metformin administration. Am J Hypertens. 2004; 17: 223-227.
20. Behar S, Boyko V, Reicher-Reiss H. et al. Ten-years survival after acute myocardial infarction: comparison of patients with and without diabetes. SPRINT Study Group. Secondary Prevention Reinfarction Israeli Nifedipine Trial. Am Heart J. 1997; 133: 3290-3296.
21. Gottlieb SS, McCarter RJ, Vogel RA. Effect of beta-blockade on mortality among high-risk and low-risk patients after myocardial infarction. N Engl J Med. 1998; 339: 489-497.
22. Ebbehoj E, Poulsen PL, Hansen KW. et al. Effects on heart rate variability of metoprolol supplementary to on going ACE-inhibitor treatment in type I diabetic patients with abnormal albuminuria. Diabetologia. 2002; 45: 965-975.
23. Casella G, Savonitto S, Chiarella F. et al. BLITZ-1 Study Investigators. Clinical characteristics and outcome of diabetic patients with acute myocardial infarction. Data from the BLITZ-1 study. Ital Heart J. 2005; 6: 374-383.
24. Mak KH, Moliterno DJ, Granger CB. et al. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I Investigators. Global Utilization of Streptokinase and Tissue Plasminogen Activator for Occluded Coronary Arteries. J Am Coll Cardiol. 1997; 30: 171-179.
25. Weitzman S, Wang C, Rosamond WD. et al. ARIC (Atherosclerosis Risk in Communities) Surveillance Study. Is diabetes an independent risk factor for mortality after myocardial infarction? The ARIC (Atherosclerosis Risk in Communities) Surveillance Study. Acta Diabetol. 2004; 41: 77-83.
26. Lowel H, Koenig W, Engel S. et al. The impact of diabetes mellitus on survival after myocardial infarction: can it be modified by drug treatment? Results of a population-based myocardial infarction register follow-up study. Diabetologia. 2000; 43: 218-226.
27. Ishihara M, Sato H, Kawagoe T. et al. Impact of diabetes mellitus on long term survival after acute myocardial infarction in patients with single vessel disease. Heart. 2001; 86: 133-138.
28. Crowley A, Menon V, Lessard D. et al. Sex differences in survival after acute myocardial infarction in patients with diabetes mellitus (Worcester Heart Attack Study). Am Heart J. 2003; 146: 824-831.
29. Vaccarino V, Parsons L, Every NR. et al. Impact of history of diabetes mellitus on hospital mortality in men and women with first acute myocardial infarction. The National Registry of Myocardial Infarction 2 Participants. Am J Cardiol. 2000; 85: 1486-1489.
30. Pyorala K, Lehto S, De Bacquer D. et al. EUROASPIRE I Group; EUROASPIRE II Group. Risk factor management in diabetic and non-diabetic patients with coronary heart disease. Findings from the EUROASPIRE I AND II surveys. Diabetologia. 2004; 47: 1257-1265.
31. Gaede P, Vedel P, Larsen N. et al. Multifactorial intervention and cardiovascular disease in patients with type 2 diabetes. N Engl J Med. 2003; 348: 383-393.