title: Sitagliptin pretreatment in diabetes patients presenting with acute coronary syndrome: results from the Acute Coronary Syndrome Israeli Survey (ACSIS).
abstract: BACKGROUND
  Chronic treatment with currently available oral hypoglyemic medications may result in a differential effect on the clinical presentation of diabetic patients with acute coronary syndrome (ACS).
  
  
  METHODS
  We evaluated presentation characteristics and the risk for in-hospital complications and 30-day major adverse cardiovascular events (MACE) among 445 patients with diabetes mellitus enrolled in the Acute Coronary Syndrome Israeli Survey (ACSIS) 2010. Patients were categorized into 3 groups according to glucose lowering medications at time of admission for ACS: 1) DPP 4 inhibitors (as monotherapy or in combination; DPP4i), 2) Metformin (monotherapy or in combination, excluding DPP4i) and 3) other oral hypoglycemics.
  
  
  RESULTS
  Patients in the DPP4i group displayed similar baseline clinical characteristics to the other 2 groups, with the exception of a younger age and a lower frequency of prior coronary heart disease and chronic renal failure. Medical therapy with DPP4i was associated with a significantly lower in-hospital complication rate (post MI angina, re-infarction, pulmonary edema, infections, acute renal failure and better KILLIP class) (9.7%), lower rates of 30-day MACE (12.9%) and a shorter hospital stay (5.4 ± 3.8 days) as compared with patients treated with metformin (24.4%, 31.6% and 5.6 ± 5.0 days respectively) or other oral hypoglycemic drugs (45.5%, 48.5% and 7.5 ± 6.5 days respectively). Consistently, multivariate logistic regression modeling revealed that treatment with DPP4i was associated with a lower risk for in-hospital complications (OR = 0.129, p = 0.002) and 30-day MACE (OR = 0.157, p = 0.002) compared with other oral hypoglycaemic therapy.
  
  
  CONCLUSIONS
  Our data suggests that chronic treatment with DPP4i may have cardioprotective effects in diabetes patients presenting with acute coronary syndrome.
authors.affiliation: Department of Internal Medicine A Wolfson Medical Center, Holon, Israel. leibovitz@wolfson.health.gov.il
authors.forename: Eyal
authors.initials: E
authors.lastname: Leibovitz
authors.forename: Shmuel
authors.initials: S
authors.lastname: Gottlieb
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.forename: Natalie
authors.initials: N
authors.lastname: Gevrielov-Yusim
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matetzky
authors.forename: Dov
authors.initials: D
authors.lastname: Gavish
mesh_terms: D054058:Acute Coronary Syndrome / Q000150:complications* / Q000517:prevention & control; D000368:Aged; D000369:Aged, 80 and over; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000188:drug therapy*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use*; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008687:Metformin / Q000627:therapeutic use; D008875:Middle Aged; D015999:Multivariate Analysis; D011719:Pyrazines / Q000627:therapeutic use*; D012189:Retrospective Studies; D055502:Secondary Prevention; D000068900:Sitagliptin Phosphate; D016896:Treatment Outcome; D014230:Triazoles / Q000627:therapeutic use*
chemical_list: D007004:Hypoglycemic Agents; D011719:Pyrazines; D014230:Triazoles; D008687:Metformin; D000068900:Sitagliptin Phosphate
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