Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-ST-Elevation Acute Coronary Syndromes: A Contemporary National Insight.
BACKGROUND
There are limited data on the merits of an early invasive strategy in diabetics with non-ST-elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in-hospital survival of diabetics with non-ST-elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy.


RESULTS
The National Inpatient Sample database, years 2012-2013, was queried for diabetics with a primary diagnosis of non-ST-elevation acute coronary syndrome defined as either non-ST-elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in-hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non-ST-elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in-hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39-0.42;P<0.0001) and propensity-matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50-0.63;P<0.0001). The benefit was observed across various subgroups, except for patients with unstable angina (Pinteraction=0.02).


CONCLUSIONS
An early invasive strategy may be associated with a lower incidence of in-hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non-ST-elevation myocardial infarction compared with unstable angina.
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.
Ahmed N
AN
Mahmoud
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.
Islam Y
IY
Elgendy
Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL.
Hend
H
Mansoor
College of Pharmacy, University of Rhode Island, Kingston, RI.
Xuerong
X
Wen
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.
Mohammad K
MK
Mojadidi
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.|Cardiology Section (111D), North Florida/South Georgia Veterans Health System Malcom Randall Veterans Administration Medical Center Medical Service, Gainesville, FL.
Anthony A
AA
Bavry
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL david.anderson@medicine.ufl.edu.
R David
RD
Anderson
D054058:Acute Coronary Syndrome / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D000368:Aged; D002423:Cause of Death / Q000639:trends; D017023:Coronary Angiography; D003920:Diabetes Mellitus / Q000401:mortality*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D017052:Hospital Mortality / Q000639:trends; D006760:Hospitalization / Q000639:trends; D006801:Humans; D008297:Male; D009204:Myocardial Revascularization / Q000592:standards*; D016017:Odds Ratio; D017410:Practice Guidelines as Topic; D057216:Propensity Score; D015203:Reproducibility of Results; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology
acute coronary syndrome; early invasive strategy; mortality; propensity score analysis