Ischemic heart disease mortality risk in patients with diabetes mellitus]

The significance of clinical characteristics during acute phase of coronary syndrome for hospital prognosis is well established. However their prognostic ability and impact on defining risk of lethal outcome during one-year period after acute coronary syndrome in pts with diabetes mellitus is not clarified.In a prospective one-year study 699 pts with first acute coronary syndrome were studied: 61 with diabetes mellitus and 638 without diabetes mellitus. We have analyzed their demographic characteristics, risk factors of ischemic heart disease, clinical, echocardiographic, angiographic data. During one year follow up period there were 61 cases of cardiac death.Univariate analysis showed, that pts with diabetes mellitus vs pts without diabetes mellitus more often were female, aged >65 years, had arterial hypertension, obesity and sinusal tachycardia, severe acute left ventricular failure, three - vessel coronary disease, episodes of paroxysmal atrial flutter during acute phase of acute coronary syndrome (p<0.05). Multivariate logistic regression analysis showed that these variables remained independent predictors for lethal outcome and had OR from 1.6 to 9.5 in pts without diabetes mellitus. The presence of diabetes mellitus increased the value of OR of these variables 1.5-2.5 fold and this followed to the further stratification of pts. The value > and =14 of general risk score in multivariate model indicated the high risk for lethal outcome during one-year period. Almost half of pts (48.3%) with diabetes mellitus had the high risk, a 36.5 percent of them died during follow up. The sensitivity of risk score in predicting mortality was 37.3 percent in high risk group and 58.8 percent in low risk group, specificity--96.7 percent and 82.7 percent respectively.These results imply that the presence of diabetes mellitus in pts with acute coronary syndrome increases risk for lethal outcome two-fold during one-year period after acute coronary syndrome.