title: Underuse of an invasive strategy for patients with diabetes with acute coronary syndrome: a nationwide study.
abstract: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes.
  
  
  
  The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001).
  
  
  
  In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.
authors: Department of Cardiology , Hvidovre University Hospital , Hvidovre , Denmark.
authors: Ida
authors: I
authors: Gustafsson
authors: Department of Cardiology , Gentofte University Hospital , Hellerup , Denmark ; National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; Danish Heart Registry , Copenhagen , Denmark.
authors: Anders
authors: A
authors: Hvelplund
authors: Department of Cardiology , Gentofte University Hospital , Hellerup , Denmark.
authors: Kim Wadt
authors: KW
authors: Hansen
authors: Department of Cardiology , Gentofte University Hospital , Hellerup , Denmark.
authors: Søren
authors: S
authors: Galatius
authors: Institute of Public Health, University of Copenhagen , Copenhagen , Denmark.
authors: Mette
authors: M
authors: Madsen
authors: Department of Cardiology , Gentofte University Hospital , Hellerup , Denmark ; Faculty of Health Sciences , Institute of Surgery and Internal Medicine, University of Copenhagen , Copenhagen , Denmark.
authors: Jan Skov
authors: JS
authors: Jensen
authors: Department of Cardiology , Rigshospitalet , Copenhagen , Denmark.
authors: Hans-Henrik
authors: HH
authors: Tilsted
authors: Department of Cardiology , Aarhus University Hospital , Skejby , Denmark.
authors: Christian Juhl
authors: CJ
authors: Terkelsen
authors: Department of Cardiology , Odense University Hospital , Odense , Denmark.
authors: Lisette Okkels
authors: LO
authors: Jensen
authors: Department of Cardiology , Rigshospitalet , Copenhagen , Denmark.
authors: Erik
authors: E
authors: Jørgensen
authors: Department of Cardiology , Gentofte University Hospital , Hellerup , Denmark ; Danish Heart Registry , Copenhagen , Denmark.
authors: Jan Kyst
authors: JK
authors: Madsen
authors: National Institute of Public Health, University of Southern Denmark , Copenhagen , Denmark ; Danish Heart Registry , Copenhagen , Denmark ; Department of Cardiology , Bispebjerg University Hospital , Copenhagen , Denmark.
authors: Steen Zabell
authors: SZ
authors: Abildstrøm