[12-month outcomes of diabetic and non-diabetic patients with acute coronary syndromes assigned to early invasive treatment strategy].
BACKGROUND
Epidemiological studies show that diabetes mellitus is a serious medical, economic and public health problem. 21-30% of patients with acute coronary syndromes (ACS) have diabetes. We aimed at assessing the in-hospital and 12-month outcomes of diabetic and non-diabetic patients with ACS without ST-segment elevation.


METHODS
329 consecutive patients with ACS without ST-segment elevation were entered into the study, of whom 63 patients (19.1%) had diabetes mellitus. The inclusion criteria were: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (< 20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or = 0.1 mV) in at least 2 continuous leads, positive serum cardiac markers. All patients underwent coronary angiography and percutaneous coronary intervention (PCI) within the first 24 hours of admission.


RESULTS
Baseline profiles were similar in both groups. More non-diabetic patients had initial TIMI 3 flow (76% vs 65%, p = 0.05), whereas the rate of successful PCI (final TIMI 3 flow) was similar in both groups (97.7% vs 96.8%, NS). The rate of GP IIb/IIIa inhibitors treatment was similar in both groups. Overall mortality in the diabetic group and in the non-diabetic group was 7.9% and 3.4% respectively (NS). In-hospital mortality rate was 3.2% and 1.1% respectively (NS). After discharge, 9 patients died, of whom 3 patients were in the diabetic group and 6 patients in the non-diabetic group (5.0% vs 2.28% NS). The rate of MI during follow-up was similar in both groups. More diabetic patients had episodes of unstable angina during follow-up (30% vs 17.9%, p = 0.034). Primary endpoint (death, myocardial infarction, repeat revascularization) was more frequent in the diabetic patients (28.57% vs 17.67%, p = 0.05), whereas the rate of combined endpoint (death, myocardial infarction, repeat revascularization, cardiovascular hospitalization) was similar in both groups (40% vs 26.23%, NS). More diabetic patients received beta-blockers, diuretics and digoxin during follow-up.


CONCLUSIONS
Early invasive treatment and intensive medical therapy improves in-hospital prognosis for diabetic patients, whereas diabetes mellitus affects long-term outcomes with more episodes of unstable angina and a more frequent rate of repeat revascularization.
Szyguła-Jurkiewicz
Bozena
B
Oddział Kliniczny Kardiologii S1. AM, Zabrze.
Wilczek
Krzysztof
K
Osuch
Marcin
M
Poloński
Lech
L
D000208:Acute Disease; D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D048909:Diabetes Complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006329:Heart Conduction System / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D016896:Treatment Outcome