Impact of diabetes mellitus on long-term outcome after unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy.
OBJECTIVE
We sought to evaluate the impact of diabetes mellitus on long-term outcome in patients with unstable angina and non-ST-segment elevation myocardial infarction treated with a very early invasive strategy.


METHODS
We carried out a prospective cohort study in 270 diabetic and 1163 non-diabetic patients with unstable angina and non-ST-segment elevation myocardial infarction. All patients underwent coronary angiography and, if appropriate, subsequent revascularisation within 24 hours of admission. The primary endpoint was all-cause mortality during follow-up for up to 60 months.


RESULTS
Diabetic patients had less favourable baseline characteristics including more advanced coronary artery disease and more severe unstable angina and non-ST-segment elevation myocardial infarction. Percutaneous coronary intervention was performed in 53% of diabetic patients and 56% of non-diabetic patients. Coronary artery bypass grafting was done in 21% of diabetic patients and 12% of non-diabetic patients. In-hospital mortality (4.1% vs 1.3%; hazard ratio 3.47; 95% CI: 1.57 to 7.64; p=0.002) and long-term mortality (9.7% vs 4.9%; hazard ratio 2.11; 95% CI: 1.33 to 3.36; p=0.002) were significantly higher in diabetic patients. After adjustment for differences in baseline characteristics, diabetes mellitus was no longer an independent predictor of long-term mortality (hazard ratio 1.43; 95% CI: 0.74 to 2.78; p=0.292).


CONCLUSIONS
Diabetic patients treated with a very early invasive strategy for unstable angina and non-ST-segment elevation myocardial infarction have a higher in-hospital and long-term mortality that is largely explained by their less favourable baseline characteristics including more advanced coronary artery disease and more severe unstable angina and non-ST-segment elevation myocardial infarction.
Müller
C
C
The Heart Center Bad Krozingen, Germany. chmueller@uhbs.ch.|Departement Innere Medizin, Medizinische Universitätsklinik Basel, Petersgraben 4, 4031, Basel, Switzerland. chmueller@uhbs.ch.
Neumann
F J
FJ
The Heart Center Bad Krozingen, Germany.
Ferenc
M
M
The Heart Center Bad Krozingen, Germany.
Perruchoud
A P
AP
Departement Innere Medizin, Medizinische Universitätsklinik Basel, Petersgraben 4, 4031, Basel, Switzerland.
Büttner
H J
HJ
The Heart Center Bad Krozingen, Germany.
D000368:Aged; D000789:Angina, Unstable / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000453:epidemiology* / Q000401:mortality; D003924:Diabetes Mellitus, Type 2 / Q000453:epidemiology / Q000628:therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000453:epidemiology; D012189:Retrospective Studies; D015607:Stents; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome