OBJECTIVE To determine prospectively the survival of previously known diabetic patients admitted to coronary care unit with confirmed myocardial infarction (MI) over a one-year period and to assess the effects of gender, age, diabetes duration, hyperglycemia, hypertension, and anti-diabetic treatment on survival. METHODS In this prospective cohort study, we followed 59 patients hospitalized with a confirmed myocardial infarction at 3 coronary care units, Peshawar (Pakistan), between May 1, 2000 and April 30, 2001. We analyzed survival using univariate and multivariate Cox Proportional hazards regression models to control for potentially confounding factors. RESULTS A total of 17 (28.8%) subjects (7 male and 10 female) died. Survival was significantly associated with previous history of hypertension and duration of diabetes (HR = 3.40, 95% CI = 1.33-9.22, P = 0.001, and HR = 1.24, 95% CI = 1.05-1.45, P = 0.009, by Univariate Cox model, respectively). In multivariate analysis duration of diabetes was significantly associated with survival and Metformin treatment only, and Sulphonylurea & Metformin treatment together (P = 0.003, and 0.026, Multivariate Cox model, respectively). CONCLUSIONS Our results suggested that diabetes is associated with markedly increased mortality in the presence of hypertension after acute myocardial infarction and support for aggressive treatment of coronary risk factors among diabetic patients.