Background: Diabetic (DM) patients are at increased risk of cardiovascular events after an acute coronary syndrome, yet it remains unknown whether they derive enhanced benefit from an invasive strategy. Objective: We investigated the relation between coronary revascularization by percutaneus coronary intervention (PCI) and in-hospital survival of DM patients admitted to hospitals with a diagnosis of Unstable angina/ Non-ST-elevation myocardial infarction (UA/NSTEMI). Methods: This was a prospective cohort study using data from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACSTC, NCT01218776) registry on patients admitted to the coronary care units of 58 Eastern European hospitals from January 2010 to February 2015. A total of 4,996 first-day survivors who were admitted with a diagnosis of UA/NSTEMI were included. To avoid survival bias, a landmark time was set to 24 hours after hospital admission. Patients who died before the landmark time were excluded. Patients, who had undergone coronary artery bypass grafting, were also excluded leaving a final study population of 4,965 patients. Results: The study populations consisted of 4,965 NSTE-ACS patients. There were 1,381 patients (27.8%) with DM. Patients with DM were older and prevalently women, and had higher rates of hypercholesterolemia, hypertension, prior cardiovascular events and chronic kidney disease. They had more severe clinical presentation and higher rates of atypical chest pain. Patients with DM underwent less (p<0.001) PCI (58.9% versus 65.9%) and had significantly higher (p<0.001) in-hospital mortality (6.2% versus 3.7%) than their non- DM counterpart. Multivariate regression analyses showed DM as a predictor of in-hospital mortality in patients who did not undergo PCI (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.18–4.13, p=0.013), but not in those who underwent revascularization (OR: 1.79, 95% CI: 0.60–5.32, p=0.29). Conclusions: There is an independent association between DM and in hospital mortality in UA/NSTEMI patients who were not offered coronary revascularization. An invasive strategy has significant effect in reducing the likelihood of cardiovascular death in diabetic patients.

Benefit of early invasive therapy for diabetic patients with NSTE ACS. A landmark study from the ISACS-TC registry

RICCI, BEATRICE;CENKO, EDINA;MANFRINI, OLIVIA;BUGIARDINI, RAFFAELE
2015

Abstract

Background: Diabetic (DM) patients are at increased risk of cardiovascular events after an acute coronary syndrome, yet it remains unknown whether they derive enhanced benefit from an invasive strategy. Objective: We investigated the relation between coronary revascularization by percutaneus coronary intervention (PCI) and in-hospital survival of DM patients admitted to hospitals with a diagnosis of Unstable angina/ Non-ST-elevation myocardial infarction (UA/NSTEMI). Methods: This was a prospective cohort study using data from the International Survey of Acute Coronary Syndromes in Transitional Countries (ISACSTC, NCT01218776) registry on patients admitted to the coronary care units of 58 Eastern European hospitals from January 2010 to February 2015. A total of 4,996 first-day survivors who were admitted with a diagnosis of UA/NSTEMI were included. To avoid survival bias, a landmark time was set to 24 hours after hospital admission. Patients who died before the landmark time were excluded. Patients, who had undergone coronary artery bypass grafting, were also excluded leaving a final study population of 4,965 patients. Results: The study populations consisted of 4,965 NSTE-ACS patients. There were 1,381 patients (27.8%) with DM. Patients with DM were older and prevalently women, and had higher rates of hypercholesterolemia, hypertension, prior cardiovascular events and chronic kidney disease. They had more severe clinical presentation and higher rates of atypical chest pain. Patients with DM underwent less (p<0.001) PCI (58.9% versus 65.9%) and had significantly higher (p<0.001) in-hospital mortality (6.2% versus 3.7%) than their non- DM counterpart. Multivariate regression analyses showed DM as a predictor of in-hospital mortality in patients who did not undergo PCI (odds ratio [OR] 2.21, 95% confidence interval [CI] 1.18–4.13, p=0.013), but not in those who underwent revascularization (OR: 1.79, 95% CI: 0.60–5.32, p=0.29). Conclusions: There is an independent association between DM and in hospital mortality in UA/NSTEMI patients who were not offered coronary revascularization. An invasive strategy has significant effect in reducing the likelihood of cardiovascular death in diabetic patients.
B. Ricci; E. Cenko; Z. Vasiljevic; M. Dorobantu; O. Gustiene; B. Knezevic; M. Dilic; O. Manfrini; L. Badimon; R. Bugiardini
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/11585/528477
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