Effect of Diabetes Mellitus on Frequency of Adverse Events in Patients With Acute Coronary Syndromes Undergoing Percutaneous Coronary Intervention.
Few data are available on the timing of adverse events in relation to the status of diabetes mellitus and the type of acute coronary syndrome (ACS). We investigated this issue in diabetic and nondiabetic patients admitted with a diagnosis of non-ST-segment elevation ACS (NSTE-ACS) or ST-segment elevation myocardial infarction (STEMI) undergoing percutaneous coronary intervention. Patient-level data from 6 studies (n = 16,601) were pooled and only patients with ACS are included (n = 9,492). Early (0 to 30 days), late (31 to 365 days), and overall (0 to 365 days) events were analyzed. Diabetes mellitus was present in 1,927 patients (20.3%). At 1 year, all-cause mortality was highest for diabetic patients with STEMI (13.4%), followed by diabetic patients with NSTE-ACS (10.3%), nondiabetic patients with STEMI (6.4%) and nondiabetic patients with NSTE-ACS (4.4%; p <0.001). Among patients with diabetes, there was a significant interaction (p <0.001) for STEMI versus NSTE-ACS in early compared with late mortality, due to an excess of early mortality associated with STEMI (9.3% vs 3.7%; hazard ratio 2.31, 95% CI 1.52 to 3.54, p <0.001). Compared with diabetic NSTE-ACS patients, diabetic patients with STEMI had an increased risk of early stent thrombosis (hazard ratio 2.26, 95% CI 1.48 to 3.44, p <0.001), as well as a significant interaction (p = 0.009) in the risk of target lesion revascularization between the early and late follow-up. The distribution of fatal and nonfatal events according to the type of ACS was not influenced by diabetic status. In conclusion, diabetes in ACS setting confers a worse prognosis with 1-year mortality >10% in both STEMI and NSTE-ACS. Notwithstanding the high absolute rates, the temporal distribution of adverse events related to the type of ACS is similar between diabetic and nondiabetic patients.
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Raffaele
R
Piccolo
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Anna
A
Franzone
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Konstantinos C
KC
Koskinas
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Lorenz
L
Räber
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Thomas
T
Pilgrim
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Marco
M
Valgimigli
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland.
Stefan
S
Stortecky
Institute of Social and Preventive Medicine, Clinical Trials Unit, University of Bern, Bern, Switzerland.
Julie
J
Rat-Wirtzler
Department of Cardiology, Heart Center at the Isar, Munich, Germany.
Sigmund
S
Silber
International Centre for Circulatory Health, Imperial College London, London, United Kingdom.
Patrick W
PW
Serruys
Institute of Primary Health Care, University of Bern, Bern, Switzerland; Department of Medicine, Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael's Hospital, University of Toronto, Toronto, Canada.
Peter
P
Jüni
Institute of Social and Preventive Medicine, Clinical Trials Unit, University of Bern, Bern, Switzerland; Department of Clinical Research, Clinical Trials Unit, University of Bern, Bern, Switzerland.
Dik
D
Heg
Department of Cardiology, Bern University Hospital, University of Bern, Bern, Switzerland. Electronic address: stephan.windecker@insel.ch.
Stephan
S
Windecker
D054058:Acute Coronary Syndrome / Q000453:epidemiology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D003920:Diabetes Mellitus / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*; D062645:Percutaneous Coronary Intervention; D011183:Postoperative Complications / Q000453:epidemiology*; D011379:Prognosis; D016016:Proportional Hazards Models; D016032:Randomized Controlled Trials as Topic; D000072657:ST Elevation Myocardial Infarction / Q000453:epidemiology / Q000601:surgery*