When an MI occurs in a patient with diabetes, in-hospital, pre-hospital, and one-year mortality is approximately double that of a non-diabetic MI patient. Included in this poor prognosis is an increased prevalence of ventricular fibrillation, atrial fibrillation, and heart failure (HF).^2,3 Indeed, even with a less than ‘full-thickness’ infarct of the ventricular wall (a non-ST segment elevation MI [STEMI]), the prognosis for the patient with diabetes approaches that of the non-diabetic with a full-thickness infarct (STEMI). When a cardiac arrest occurs in a patient with diabetes, the chances of being discharged from hospital are greatly decreased.

Interventions in patients with diabetes are also less successful. Angioplasty with or without stent placement, fibrinolysis, and coronary artery bypass grafting are less efficacious. The re-stenosis rate following stent placement in a patient with diabetes is increased, and while drug-eluting stents (DES) reduce stenosis by two-thirds, re-interv ntion is still twice as frequent in those with diabetes.⁴ This is particularly true in those who require insulin and/or have multiple vessel disease. The more deadly complication of stent thrombosis is increased by 80% in those with diabetes, and again this is more common in those who require insulin and/or have multiple vessel disease.⁵ However, in patients with diabetes, stent placement following an MI results in a decrease in recurrent MI, stroke, and death compared with fibrinolysis alone.

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