Article

While patients with diabetes mellitus (DM) have more extensive coronary
disease and worse survival after acute myocardial infarction (AMI) than patients
without DM, data on whether they experience more angina are conflicting. METHODS:
We examined angina prevalence over the year following AMI among 3367 patients,
including 1080 (32%) with DM, from 24 US hospitals enrolled in the TRIUMPH
registry from 2005 to 2008. RESULTS: Patients with vs. without DM were more
likely to be treated with antianginal medications both at discharge and over
follow up. Despite more aggressive angina therapy, patients with vs. without DM
had higher prevalence and severity of angina prior to AMI (49 vs. 43%, p = 0.001)
and at each follow-up assessment, although rates of angina declined in both
groups over time. In a hierarchical, multivariable, repeated-measures model that
adjusted for multiple demographic and clinical factors including severity of
coronary disease and in-hospital revascularization, DM was associated with a
greater odds of angina over the 12 months of follow up; this association
increased in magnitude over time (12-month OR 1.18, 95% CI 1.01-1.37; DM*time p
interaction = 0.008). CONCLUSIONS: Contrary to conventional wisdom, angina is
more prevalent and more severe among patients with DM, both prior to and
following AMI. This effect is amplified over time and independent of patient and
treatment factors, including the presence of multivessel disease and coronary
revascularization. This increased burden of angina may be due to more diffuse
nature of coronary disease, more rapid progression of coronary disease over time,
or greater myocardial demand among DM patients.
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Langue : ANGLAIS