Coronary artery disease
Comparison of Treatment and Outcome of Acute Coronary Syndrome in Patients With Versus Patients Without Diabetes Mellitus

https://doi.org/10.1016/j.amjcard.2008.11.034Get rights and content

The aim was to evaluate management and outcomes in patients with diabetes mellitus (DM) with acute coronary syndrome (ACS). The EHS-ACS-II was a multinational survey conducted in 2004 that included 6,385 consecutive patients with ACS. The management and outcomes of patients with and without DM were compared. DM was recognized in 1,587 patients (25%) with ACS. Patients with DM had a less favorable risk-factor profile, less typical presentation, and longer delay in seeking medical attention; presented more frequently with arrhythmias, heart failure, renal failure, and major bleeding; and had higher in-hospital and 1-year mortality. They were treated more often with diuretics and inotropic agents and less often with antiaggregants (glycoprotein IIb/IIIa and clopidogrel). Insulin was administered to 53% of patients with DM during hospitalization and 31% at discharge. Patients with DM with ST-elevation (STE) myocardial infarction underwent similar primary percutaneous and coronary interventions (but received less thrombolytic therapy). Patients with DM with non-STE ACS underwent less in-hospital revascularization and had significantly higher 1-year mortality. Multivariable analyses showed DM as a predictor of 1-year mortality (odds ratio 1.37, 95% confidence interval 1.09 to 1.71), but not in-hospital mortality. In conclusion, given the current treatment, patients with and without DM with ACS had similar in-hospital adjusted mortality, but patients with DM had increased 1-year mortality. Patients with DM with non-STE ACS posed a higher risk group.

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Methods

The details of the EHS-ACS-II have been previously described.1 The survey was conducted in 190 volunteering medical centers from 32 member countries of the EHS. Enrolment began March 2004 and ended October 2004. Participating centers were asked to recruit 30 to 50 consecutive patients fulfilling the survey inclusion criterion of a confirmed diagnosis of ACS. In addition to data regarding the prehospital and in-hospital course, follow-up data were collected using telephone interview or personal

Results

Of 6,385 patients with a final diagnosis of ACS enrolled in the EHS-ACS-II, documentation of DM status was available for 6,349 (99%). DM was reported in 1,587 patients (25.0%), 24.9% of whom were treated using insulin and 54.0% were treated using oral hypoglycemic medication. Baseline characteristics of patients with ACS with and without DM presenting with STE and non-STE ACS are listed in Table 1. Patients with DM were significantly older, were more often women, and had higher prevalences of

Discussion

In our analysis, 25% of patients with ACSs had known DM on admission. This was similar to results from previous large-scale clinical surveys2, 3 and the previous Euro Heart Survey ACS-I, in which 23% had a previous diagnosis of DM.4 It was previously recognized that patients with ACS with DM comprised a distinctive risk group in patients with ACSs. We found that patients with DM in our cohort had a less favorable risk-factor profile and more previous diagnoses of cardiovascular and renal

Acknowledgment

Dr. Hasin had full access to all data in the study and takes responsibility for the integrity of the data and accuracy of data analysis.

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