title: Temporal trends in management and outcome of diabetic and non-diabetic patients with acute coronary syndrome (ACS): residual risk of long-term mortality persists: Insights from the ACS Israeli Survey (ACSIS) 2000-2010.
abstract: OBJECTIVE
  In the past diabetes was strongly associated with elevated mortality rate after acute coronary syndrome (ACS). Over the past decade a treatment of the ACS has evolved rapidly with major advances in the management techniques. The aim of the present study was to compare temporal trends of the outcomes of diabetic vs. non-diabetic patients using nationwide data.
  
  
  METHODS
  We evaluated time-dependent changes in the clinical characteristics, management strategies, and outcomes of diabetic and non-diabetic patients enrolled in the biannual ACS Israeli Surveys (ACSIS) between 2000 and 2010. We divided the survey into early (2000-2005) vs. late (2006-2010) periods.
  
  
  RESULTS
  There were 3964 diabetic and 7322 non-diabetic patients, a total of 11,472 ACS patients. Although diabetic patients were significantly younger, they displayed more advanced coronary artery disease and considerably higher rates of all-cause mortality at 30 days and 1-year. Both diabetic and non-diabetic patients who were enrolled in the late survey period received more evidence-based therapies (primary PCI, guideline-based medications) and experienced a better 1-year survival probability (respectively 88% vs. 84% and 93% vs. 90%; all p-values<0.01). Multivariate analysis demonstrated that diabetes and early survey period were each independently associated with a significantly increased mortality risk (respectively 39% and 25%, p<0.001 for both).
  
  
  CONCLUSIONS
  Our data suggest that despite the overall improvement in the management and outcomes of the ACS, diabetic patients are still at increased residual risk of long-term mortality that needs to be further addressed.
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Robert
authors.initials: R
authors.lastname: Klempfner
authors.affiliation: Internal Medicine, Rabin Medical Center, Petah Tikva, Israel.
authors.forename: Avishay
authors.initials: A
authors.lastname: Elis
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Shlomi
authors.initials: S
authors.lastname: Matezky
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Gad
authors.initials: G
authors.lastname: Keren
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Arie
authors.initials: A
authors.lastname: Roth
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ariel
authors.initials: A
authors.lastname: Finkelstein
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Shmuel
authors.initials: S
authors.lastname: Banai
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Goldenberg
authors.affiliation: Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors.forename: Enrique Z
authors.initials: EZ
authors.lastname: Fisman
authors.affiliation: Department of Cardiology, Sheba Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel; Cardiovascular Diabetology Research Foundation, Holon, Israel.
authors.forename: Alexander
authors.initials: A
authors.lastname: Tenenbaum
authors.affiliation: Department of Cardiology, Tel Aviv Medical Center, Tel Aviv, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Israel. Electronic address: yaronarbel@gmail.com.
authors.forename: Yaron
authors.initials: Y
authors.lastname: Arbel
mesh_terms: D054058:Acute Coronary Syndrome / Q000401:mortality* / Q000628:therapy*; D000367:Age Factors; D000368:Aged; D048909:Diabetes Complications / Q000401:mortality* / Q000628:therapy*; D018450:Disease Progression; D005260:Female; D019983:Guideline Adherence; D017052:Hospital Mortality; D006801:Humans; D007557:Israel / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Acute coronary syndrome; Diabetes mellitus; Prognosis; Therapy; Trends