The Munich Myocardial Infarction Registry

Abstract

Diabetes and cardiovascular diseases are closely connected fields of medicine. Diabetes is a major risk factor and cause of cardiovascular disease and many patients with cardiovascular disorders, not the least coronary heart disease, have glucometabolic perturbations (1). Diabetic patients without a previous myocardial infarction have a risk for cardiac mortality of 20% over 7 years, which is largely equal to the risk of nondiabetic patients after myocardial infarction (3). Furthermore, the risk for cardiovascular mortality in diabetic patients with acute myocardial infarction over a time period of 7 years has been observed to be up to 45% (3). In diabetic patients with acute myocardial infarction, hospital mortality has also been reported to be substantially enhanced (4). A twofold increase in total hospital mortality has been reported in these patients (5). In 1999, the Munich Myocardial Infarction Registry reported a nearly threefold increase in hospital mortality within 24 h after admission (6). A total of 14% of diabetic patients with acute myocardial infarction died within the first 24 h compared with 5% in nondiabetic patients (6). The Munich Myocardial Infarction Registry focuses on the inpatient management of acute myocardial infarction. Although mortality-reducing effects of evidence-based treatment like reperfusion are equally beneficial in patients with and without diabetes, evidence-based treatment has formerly somehow been demonstrated to be less used in diabetic patients (4,6,7). The initial analysis of the Munich Myocardial Infarction Registry confirmed the underuse of early treatment strategies in diabetic patients (6). Coronary angiography, percutaneous transluminal balloon coronary angioplasty, and stenting were performed less frequently in diabetic patients than in nondiabetic patients (6). The underuse had also been reported in previous registries: the Swedish registry (Register of Information and Knowledge about Swedish Heart Intensive Care Admission [RIKS-HIA]) included patients with myocardial infarction, who were admitted between …