title: [Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes].
abstract: OBJECTIVE
  In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy.
  
  
  METHODS
  Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression.
  
  
  RESULTS
  We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel.
  
  
  CONCLUSIONS
  The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS.
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España. Electronic address: anna.baeza@coma.es.
authors.forename: Anna
authors.initials: A
authors.lastname: Baeza Román
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: Jaime
authors.initials: J
authors.lastname: Latour Pérez
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: Eva
authors.initials: E
authors.lastname: de Miguel Balsa
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: Karel
authors.initials: K
authors.lastname: Pino Izquierdo
authors.affiliation: Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España.
authors.forename: Francisco Javier
authors.initials: FJ
authors.lastname: Coves Orts
authors.affiliation: Unidad de Cuidados Intensivos, Hospital Dr. Peset, Valencia, España.
authors.forename: Luis
authors.initials: L
authors.lastname: García Ochando
authors.affiliation: Unidad de Cuidados Intensivos, Complexo Hospitalario Universitario de Ourense, Ourense, España.
authors.forename: Maria José
authors.initials: MJ
authors.lastname: de la Torre Fernández
mesh_terms: D054058:Acute Coronary Syndrome / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D048909:Diabetes Complications / Q000401:mortality / Q000601:surgery*; D005260:Female; D019983:Guideline Adherence / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013030:Spain; D016896:Treatment Outcome
keywords: Acute coronary syndrome without ST elevation; Diabetes mellitus; Early invasive strategy; Estrategia invasiva precoz; Síndrome coronario agudo sin elevación de ST