Diabetic patients with acute coronary syndromes in contemporary European registries: characteristics and outcomes.
Among patients with acute coronary syndromes (ACS), those with diabetes mellitus (DM) are at particularly high risk of recurrent cardiovascular events and premature death. We aimed to provide a descriptive overview of unadjusted analyses of patient characteristics, ACS management, and outcomes up to 1 year after hospital admission for an ACS/index-ACS event, in patients with DM in contemporary registries in Europe.



A total of 10 registries provided data in a systematic manner on ACS patients with DM (total n =28 899), and without DM (total n= 97 505). In the DM population, the proportion of patients with ST-Segment Elevation Myocardial Infarction (STEMI) ranged from 22.1% to 64.6% (other patients had non-ST-Segment Elevation Myocardial Infarction (NSTEMI-ACS) or unstable angina). All-cause mortality in the registries ranged from 1.4% to 9.4% in-hospital; 2.8% to 7.9% at 30 days post-discharge; 5.1% to 10.7% at 180 days post-discharge; and 3.3% to 10.5% at 1 year post-discharge. Major bleeding events were reported in up to 3.8% of patients while in hospital (8 registries); up to 1.3% at 30 days (data from two registries only), and 2.0% at 1 year (one registry only). Registries differed substantially in terms of study setting, site, patient selection, definition and schedule of endpoints, and use of various P2Y12 inhibitors. In most, but not all, registries, event rates in DM patients were higher than in patients without DM. Pooled risk ratios comparing cohorts with DM vs. no DM were in-hospital significantly higher in DM for all-cause death (1.66; 95% CI 1.42-1.94), for cardiovascular death (2.33; 1.78 - 3.03), and for major bleeding (1.35; 1.21-1.52).



These registry data from real-life clinical practice confirm a high risk for recurrent events among DM patients with ACS, with great variation across the different registries.
Cardiology Unit, Humanitas Research Hospital, Rozzano (Milano), Italy.
Maddalena
M
Lettino
Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Pontus
P
Andell
Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany.
Uwe
U
Zeymer
Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Petr
P
Widimsky
Department of Cardiology, Hospital Européen Georges Pompidou and Université Paris Descartes, Paris, France.
Nicolas
N
Danchin
Institut d'Investigació Sanitària Pere Virgili, Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain.
Alfredo
A
Bardaji
Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain.
Jose A
JA
Barrabes
Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain.
Angel
A
Cequier
Department of Cardiology, University Hospital Antwerp, Edegem, Belgium.
Marc J
MJ
Claeys
Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology, European Hospital, Rome, Italy.
Leonardo
L
De Luca
University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria.
Jakob
J
Dörler
Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
David
D
Erlinge
AMIS-Plus Data Center, University of Zurich, Zurich, Switzerland.
Paul
P
Erne
Pôle de L'urgence, Service de d'Aide Médicale Urgente du Nord, Centre Hospitalier Régional, Universitaire de Lille, Lille, France.
Patrick
P
Goldstein
Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden.
Sasha M
SM
Koul
Cardiac Intensive Care Unit, Interventional Cardiology Hospital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France.
Gilles
G
Lemesle
Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Thomas F
TF
Lüscher
Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Christian M
CM
Matter
Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France.
Gilles
G
Montalescot
AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Dragana
D
Radovanovic
Cardiology Department, Hospital La Paz, Madrid, Spain, IdiPaz.
Jose Lopez
JL
Sendón
Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic.
Petr
P
Tousek
2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria.
Franz
F
Weidinger
Swansea University, Medical School, Swansea, Wales, UK.
Clive F M
CFM
Weston
Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle-upon, Tyne, UK.
Azfar
A
Zaman
Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland.
Jin
J
Li
Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands.
J Wouter
JW
Jukema
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D000368:Aged; D000789:Angina, Unstable / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D001026:Coronary Artery Bypass / Q000009:adverse effects / Q000401:mortality; D003922:Diabetes Mellitus, Type 1 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000175:diagnosis / Q000453:epidemiology* / Q000401:mortality / Q000628:therapy; D005060:Europe / Q000453:epidemiology; D005260:Female; D006470:Hemorrhage / Q000139:chemically induced; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D000072658:Non-ST Elevated Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D062645:Percutaneous Coronary Intervention / Q000009:adverse effects / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000009:adverse effects / Q000627:therapeutic use*; D010818:Practice Patterns, Physicians'; D011379:Prognosis; D012008:Recurrence; D012042:Registries; D018570:Risk Assessment; D012307:Risk Factors; D000072657:ST Elevation Myocardial Infarction / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D013997:Time Factors
D010975:Platelet Aggregation Inhibitors
Acute coronary syndromes; Antiplatelets; Clopidogrel ; Diabetes mellitus; Non-ST-segment elevation; Observational; P2Y12 receptor inhibitors ; Prasugrel; ST-segment elevation; Ticagrelor; Type 2 diabetes; Unstable angina