DOES PRE-INFARCTION DIABETIC CONTROL AFFECT THE OUTCOME OF ACUTE MYOCARDIAL INFARCTION?

Abstract

Objectives: The aim of this study was to see the effect of glycemic control on the outcome of acute myocardial infarction (AMI), in well controlled and poorly
controlled diabetic patients by measuring fructosamine levels.

Methodology: This prospective observational study was done in Department of
Cardiology, Lady Reading Hospital, Peshawar, from May 2008 to December
2008. Both diabetic and nondiabetic patients having first AMI were included.
Patients having stroke, advanced renal failure or COPD were excluded. Diabetic
control was assessed on the basis of serum fructosamine level. Patients having
fructosamine level <285 micro mol/l were considered to have good control of
diabetes. All patients had standard medical treatment during their stay in hospital. One month later patients were evaluated for effort tolerance on treadmill.

Results: A total of 230 patients were studied. More diabetics were obese (36%
vs. 14%, p= 0.001), hypertensive (34% vs. 14%, p=0.001) and had evidence of
heart failure i.e. Killip class II & III (62% vs. 24%, p=0.001), IV (11% vs. 8%,
p=0.04). Diabetic patients also had higher serum fructosamine level (475 ±
115 vs. 230 ± 50 micro mol/l, p =0.002), triglyceride level (232 ± 19 vs. 160 ±
25mg%, p=0.001) and had slightly higher mortality (14% vs. 6%, p=0.19).
Diabetes was well controlled in 30 patients with fructosamine (248 ± 26 vs. 470
± 152micro mol/l, p=0.001). Heart failure was more common in patients with
poorly controlled diabetes (85% vs. 47%, p=0.001).

Conclusion: Poor Diabetic status is associated with higher morbidity following
acute myocardial infarction.