Treatment modalities of diabetes mellitus and outcomes of acute coronary syndromes.
BACKGROUND
Oral treatments for diabetes mellitus (DM) may have a deleterious effect on acute coronary syndromes (ACS) outcomes.


OBJECTIVE
We aimed to examine in-hospital mortality among patients with ACS and DM and the impact of anti-DM treatment modalities.


RESULTS
The Euro Heart Survey ACS prospectively enrolled 10484 patients across Europe and the Mediterranean basin. Of the 10214 patients with recorded DM status, 2352 (23.0%) had DM, of whom 562 were on diet alone, 1112 received oral hypoglycaemics, 561 received insulin, and 117 received both. The in-hospital mortality for ST-elevation-ACS was 9.8 and 5.7% for patients with and without DM, respectively, with an adjusted risk (95% confidence interval) of in-hospital mortality of 1.6 (1.2, 2.1). The in-hospital mortality for non-ST-elevation-ACS was 2.8 and 2.0%, accordingly, with an adjusted risk (95% confidence interval) of in-hospital mortality of 1.2 (0.8, 1.9). The in-hospital mortality for undetermined-electrocardiographic-pattern-ACS was 11.5 and 10.9%, accordingly, with an adjusted risk of in-hospital mortality of 1.1 (0.6, 2.0). Among DM patients with ST-elevation-ACS, the adjusted risks of in-hospital mortality were 1.0 for diet therapy, 0.8 (0.4, 1.5) for oral hypoglycaemics, and 1.9 (1.0, 3.8) for insulin; for DM patients and non-ST-elevation-ACS, 1.0 for diet therapy, 2.2 (0.6, 7.8) for oral hypoglycaemics, and 3.5 (1.0, 12.5) for insulin; for DM patients and undetermined-electrocardiographic-pattern-ACS, the adjusted risks of in-hospital mortality were 1.0 for diet therapy, 0.9 (0.2, 4.6) for oral hypoglycaemics, and 2.1 (0.5, 9.5) for insulin.


CONCLUSIONS
Acute coronary syndrome patients with DM, especially those with ST-elevation, had increased in-hospital mortality. Among ACS patients with DM, those receiving insulin had worse outcomes. Outcomes were similar for those on hypoglycaemics or on diet alone.
Hasdai
David
D
Rabin Medical Center, Petah Tikva, Israel. dhasdai@post.tau.ac.il
Behar
Solomon
S
Boyko
Valentina
V
Battler
Alexander
A
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D003920:Diabetes Mellitus / Q000178:diet therapy* / Q000188:drug therapy* / Q000401:mortality; D003925:Diabetic Angiopathies / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D004562:Electrocardiography; D005060:Europe / Q000453:epidemiology; D005260:Female; D006306:Health Surveys; D017052:Hospital Mortality; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D007328:Insulin / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D012042:Registries; D013577:Syndrome
D007004:Hypoglycemic Agents; D007328:Insulin