Impact Of Diabetes Mellitus And Gender On Clinical Feature And In-Hospital Mortality In Patients With Acute Myocardial Infarction

Objective:The clinical presentation and complication in women with AMI are different from men with AMI. In-hospital mortality rate of women with AMI is higher than men with AMI. In general, DM is one of the major factors influencing the outcome of patients with AMI. The aim of this article is to study the impact of gender and DM on clinical feature and in-hospital mortality in patients with AMI.Methods:A retrospective of study was carried out in 2,094 consecutive patients with AMI admitted to the department of cardiology, the second Hospital of Tianjin Medical University from 2000.1 to 2007.12. There were 1,415 men (30.5% with diabetes) and 679 women (37.6% with diabetes). All patients were divided into four groups:DM men, no DM men, DM women and no DM women. The following index analysis included baseline risk factors, prior diseases, medical/reperfusion treatment, clinical presentation, complications and angiographic findings. Survival analysis was obtained by the Kaplan-Meier method. In univariate and multivariate analysis, we specifically studied the interaction between the factors diabetes mellitus and gender in their effects on in-hospital mortality.Results:The men and women patients with DM had a worse heart function than the patients without DM separately, and the proportion of the patients with Killip grade≥Ⅲrank was 16.9% vs 10.9%, P<0.05 and 24.4% vs 18.5%, P<0.05, respectively. The women patients with DM had higher prevalence of cardiac shock and fatal arrhythmia than non-diabetic women (P<0.05). The age-adjusted risk of having acute pulmonary edema and fatal arrhythmia was nearly doubled in diabetic compared with non-diabetic women [age adjusted OR=2.092,95%CI(1.087,4.027); adjusted OR=1.966,95%CI(1.107,3.667)]. Whereas in men with diabetes were not significantly associated with increased risk of either. Women with diabetes were associated with higher in-hospital mortality than non-diabetic women, while there was no difference between men with and without diabetes. Moreover, survival curve depicted the most highest in-hospital mortality in women patients with diabetes, indicating an increasing influence of diabetes in this group over time. After adjustment for differences in age, hypertension, hyperlipemia, OMI, Killip grade≥ Ⅲrank, thrombolysis and intracoronary stenting on in-hospital mortality, our multivariate Logistic regression analysis also disclosed a statistically significant interaction between gender and diabetes and diabetes in women patients was always a statistically significant predictor of higher in-hospital mortality, regardless of with which other group the results were compared.Conclusions:Women with diabetes patients'pathogenetic condition is worse than men with diabetes after happening AMI. And they have higher prevalence of serious and fatal complications. These findings suggest a differential effect of diabetes on the pathophysiology of AMI based on the patients'gender. After adjustment in multivariate Logistic regression analysis, the interaction between gender and diabetes is statistically significant and female gender alone is not an independent predictor of in-hospital mortality. After adjustment in multivariate Logistic regression analysis, diabetes in female patients have higher in-hospital mortality than men with and without diabetes. So special attention should be provided to these female diabetic patients.