***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Background The long-term prognosis of diabetic patients with acute myocardial infa rct ion ( AMI ) treated by acute revascularization  is uncertain , and the optimal pharmacotherapy for such cases has not been fully evaluated . Methods To eluci date the long-term prognosis and prognostic factors in diabetic patients with AMI , a prospect i ve , cohort study involving 3021 consecutive AMI patients was conducted . All patients discharged alive from hospital were followed to monitor their prognosis every year . The primary endpoint of the study was all-cause mortality , and the secondary endpoint was the occurrence of major cardiovascular events . To eluci date the effect of various factors on the long-term prognosis of AMI patients with diabetes , the patients were divided into two groups matched by propensity scores and analyzed retrospectively . Results Diabetes was diagnosed in 1102 patients ( 36.5 % ) . During the index hospitalization , coronary angioplasty and coronary thrombolysis were performed in 58.1 % and 16.3 % of patients , respectively . In-hospital mortality of diabetic patients with AMI was comparable to that of non-diabetic AMI patients ( 9.2 % and 9.3 % , respectively ) . In total , 2736 patients ( 90.6 % ) were discharged alive and followed for a median of 4.2 years ( follow-up rate , 96.0 % ) . The long-term survival rate was worse in the diabetic group than in the non-diabetic group , but not significantly different ( hazard ratio , 1.20 [ 0.97 - 1.49 ] , p = 0.09 ) . On the other h and , AMI patients with diabetes showed a significantly higher incidence of cardiovascular events than the non-diabetic group ( 1.40 [ 1.20 - 1.64 ] , p < 0.0001 ) . Multivariate analysis revealed that three factors were significantly associated with favorable late outcomes in diabetic AMI patients : acute revascularization ( HR , 0.62 ) ; prescribing aspirin ( HR , 0.27 ) ; and prescribing renin-angiotensin system ( RAS ) inhibitors  ( HR , 0.53 ) . There was no significant correlation between late outcome and prescription of beta-blockers ( HR , 0.97 ) or calcium channel blockers ( HR , 1.27 ) . Although st and ard Japanese-approved doses of statins were associated with favorable outcome in AMI patients with diabetes , this was not statistically significant ( 0.67 [ 0.39 - 1.06 ] , p = 0.11 ) . Conclusions Although diabetic patients with AMI have more frequent adverse events than non-diabetic patients with AMI , the present results suggest that acute revascularization and st and ard therapy with aspirin and RAS inhibitors may improve their prognosis BACKGROUND There are limited data describing the presenting characteristics , management , and outcomes of diabetic and nondiabetic patients with an acute coronary syndrome ( ACS ) . OBJECTIVE To examine differences in these factors , patients with ST-segment elevation acute myocardial infa rct ion , non-ST-segment elevation acute myocardial infa rct ion , and unstable angina were enrolled in a large multinational coronary disease registry . METHODS The Global Registry of Acute Coronary Events is a prospect i ve observational study of patients hospitalized with an ACS at 94 hospitals in 14 countries . The study sample consisted of 5403 patients with ST-segment elevation acute myocardial infa rct ion , 4725 with non-ST-segment elevation acute myocardial infa rct ion , and 5988 with unstable angina . RESULTS Approximately 1 in 4 patients presented to participating hospitals with a history of diabetes . Patients with diabetes were older , more often women , with a greater prevalence of comorbidities , and they were less likely to be treated with effective cardiac therapies than nondiabetic patients . Patients with diabetes who developed an ACS were at increased risk for each hospital outcome examined including heart failure , renal failure , cardiogenic shock , and death . These differences remained after adjustment for potentially confounding prognostic factors . CONCLUSIONS A considerable proportion of patients with an ACS has diabetes and is at increased risk for adverse outcomes compared with patients without diabetes . There are certain proven therapeutic strategies that remain underused in the diabetic population . A more widespread awareness of this increased risk and a more diligent use of proven cardiac treatment approaches are indicated for patients with diabetes who develop an ACS The objective of this report was to examine the effects of sex and diabetic status on in-hospital mortality and 12 year survival following hospital discharge among 4109 patients hospitalized between 1974 and 1986 with acute myocardial infa rct ion . Sixteen general hospitals in the Worcester , MA , st and ard metropolitan statistical area were included . The age-adjusted in-hospital case-fatality rate was significantly higher in diabetic women ( 23.3 % ) than in non-diabetic women ( 18.9 % ) ( p < 0.05 ) while no significant difference was noted among men . Over a 12 year follow-up period , the relative risk of dying among diabetic men was 1.56 times that for non-diabetic men ( 95 % CI , 1.43 , 1.68 ) . Diabetic women were 1.57 times as likely to die as non-diabetic women ( 95 % CI , 1.45 , 1.73 ) . Among non-diabetic subjects , men had a 17 % excess risk of death compared to women ( 95 % CI , 1.09 , 1.25 ) . No significant difference in long-term mortality was noted among diabetic persons . Thus , the " female advantage " observed in the non-diabetic population was eliminated among the diabetic patients . R and omized clinical trials are needed in the diabetic population to identify specific therapies to reduce their increased risk of death Background Diabetes mellitus and admission blood glucose are important risk factors for mortality in ST segment elevation myocardial infa rct ion patients , but their relative and individual role remains on debate . Objective To analyze the influence of diabetes mellitus and admission blood glucose on the mortality of ST segment elevation myocardial infa rct ion patients su bmi tted to primary coronary percutaneous intervention .  Methods Prospect i ve cohort study including every ST segment elevation myocardial infa rct ion patient su bmi tted to primary coronary percutaneous intervention in a tertiary cardiology center from December 2010 to May 2012 . We collected  clinical , angiographic and laboratory data  during hospital stay , and performed a clinical follow-up 30 days after the ST segment elevation myocardial infa rct ion . We adjusted the multivariate analysis of the studied risk factors using the variables from the GRACE score . Results Among the 740 patients included , reported diabetes mellitus prevalence was 18 % . On the univariate analysis , both diabetes mellitus and admission blood glucose were predictors of death in 30 days . However , after adjusting for potential confounders in the multivariate analysis , the diabetes mellitus relative risk was no longer significant ( relative risk : 2.41 , 95 % confidence interval : 0.76 - 7.59 ; p-value : 0.13 ) , whereas admission blood glucose remained and independent predictor of death in 30 days ( relative risk : 1.05 , 95 % confidence interval : 1.02 - 1.09 ; p-value ≤ 0.01 ) . Conclusion In ST segment elevation myocardial infa rct ion patients su bmi tted to primary coronary percutaneous intervention , the admission blood glucose was a more accurate and robust independent predictor of death than the previous diagnosis of diabetes . This reinforces the important role of inflammation on the outcomes of this group of patients OBJECTIVES This study was design ed to study the influence of diabetes on the outcome of  unstable coronary artery disease ( CAD ) .  BACKGROUND Diabetes mellitus is a major contributor to CAD . Despite improvement in the management of patients with unstable coronary syndromes , this condition is still linked to a substantially increased mortality and morbidity among diabetic patients . Recent evidence advocates early revascularization in unstable coronary syndromes . Diabetic patients subjected to coronary interventions under stable conditions have a higher risk for complications and a more dismal prognosis than nondiabetic subjects . Accordingly , it is of considerable interest to obtain further information regarding the best possible management of diabetic patients with unstable CAD . METHODS A total of 2158 patients without and 299 with diabetes mellitus were r and omized to an early invasive or a noninvasive strategy . The severity of CAD was expressed as the number and extent of vessel involvement . RESULTS Three-vessel disease was diagnosed in 42 % of diabetic and 31 % of nondiabetic patients ( p = 0.006 ) . The percentages of patients with ST-depression and troponin-T > 0.03 microg/l at admission were comparable among diabetic and nondiabetic patients . Mortality and reinfa rct ion after 12 months were more frequent among diabetic than nondiabetic patients in both treatment groups . Diabetes remained a strong independent predictor for death and myocardial infa rct ion in multivariable analysis . The invasive strategy reduced event rate in nondiabetic patients from 12.0 % to 8.9 % ( odds ratio [ OR ] = 0.72 ; confidence interval [ CI ] 0.54 to 0.95 ; p = 0.019 ) and in diabetic patients from 29.9 % to 20.6 % ( OR 0.61 ; CI 0.36 to 1.04 ; p = 0.066 ) . In a multivariate analysis including the extent of CAD , diabetes remained a strong independent predictor of the combined end point ( relative risk [ RR ] 2.40 ; CI 1.47 to 3.91 ; p = 0.0001 ) and of mortality ( RR 5.43 ; CI 2.09 to 14.12 ; p = 0.001 ) . CONCLUSIONS An invasive strategy improved outcome for both diabetic and nondiabetic patients with unstable CAD . However , diabetes mellitus remained an independent and important risk factor for death and myocardial infa rct ion in the invasive group . Thus , factors beyond the extent of flow-limiting coronary lesions are of considerable importance for outcome in diabetic subjects with unstable coronary syndromes OBJECTIVES To determine whether type 2 diabetes mellitus and hyperglycemia on admission should be considered independent predictors of mortality in elderly adults with acute coronary syndrome ( ACS ) . DESIGN Prospect i ve cohort study . SETTING Twenty-three hospitals in Italy . PARTICIPANTS Individuals aged 75 and older with non-ST-elevation ACS ( NSTEACS ) ( mean age 82 , 47 % female ) ( N = 645 ) .  MEASUREMENTS Diabetic status and blood glucose levels were assessed on admission . Hyperglycemia was defined as glucose greater than 140 mg/dL. Multivariable Cox proportional hazard regression was used to assess the potential confounding effect of major covariates on the association between diabetic status , admission glucose , and 1-year mortality . RESULTS A history of diabetes mellitus was found in 231 participants ( 35.8 % ) , whereas 257 ( 39.8 % ) had hyperglycemia . Hyperglycemia was found in 171 participants with diabetes mellitus ( 70 % ) and 86 ( 21 % ) without diabetes mellitus . Participants with diabetes mellitus were significantly ( P < .05 ) more likely to have had prior myocardial infa rct ion and stroke and had lower ejection fraction and blood hemoglobin . Hyperglycemia was associated with lower ( P < .05 ) ejection fraction and estimated glomerular filtration rate ( eGFR ) . Diabetic status and hyperglycemia were associated with greater 1-year mortality according to univariate analysis ( 54 participants with diabetes mellitus died ( 23.4 % ) , versus 66 ( 15.9 % ) without diabetes mellitus ( hazard ratio ( HR ) = 1.5 95 % confidence interval ( CI ) = 1.0 - 2.1 ) , and 60 participants with hyperglycemia died ( 23.3 % ) , versus 60 ( 15.5 % ) without hyperglycemia ( HR=1.6 ; 95 % CI = 1.1 - 2.2 ) , but this association was not statistically significant after adjustment for ejection fraction , age , blood hemoglobin , and eGFR . CONCLUSION In elderly adults with NSTEACS , diabetes mellitus and hyperglycemia on admission are associated with higher mortality , mostly because of preexisting cardiovascular and renal damage Background Although unstable coronary artery disease is the most common reason for admission to a coronary care unit , the long-term prognosis of patients with this diagnosis is unknown . This is particularly true for patients with diabetes mellitus , who are known to have a high morbidity and mortality after an acute myocardial inf 
    Output:
    
We found no evidence for temporal changes in the incremental mortality risk associated with DM in the setting of MI .
The improvements in management of MI patients during the last decades have not been associated with a reduction of the gap between diabetic and non-diabetic patients