Diabetes confers worse prognosis for patients with ACS
Raffaele Piccolo, M.D., from the Bern University Hospital in Switzerland, and colleagues examined data on the timing of adverse events using pooled patient-level data from six studies with 16,601 patients; data were included for 9,492 patients with ACS, of whom 20.3 percent had diabetes mellitus. The authors examined early (zero to 30 days), late (31 to 365 days), and overall adverse events.
The researchers found that all-cause mortality was highest for patients with diabetes with ST-segment elevation myocardial infarction (STEMI; 13.4 percent) at one year, followed by patients with diabetes with non-ST-segment elevation ACS (NSTE-ACS, 10.3 percent), and was lower for patients without diabetes with STEMI and with NSTE-ACS (6.4 and 4.4 percent, respectively). There was a significant interaction for STEMI versus NSTE-ACS in early versus late mortality among patients with diabetes, with an excess of early mortality associated with STEMI (9.3 versus 3.7 percent; hazard ratio, 2.31). Patients with diabetes with STEMI had an increased risk of early stent thrombosis (hazard ratio, 2.26) and a significant interaction in the risk of target lesion revascularization between early and late follow-up, compared to patients with diabetes with NSTE-ACS.
"Diabetes in ACS setting confers a worse prognosis with one-year mortality >10 percent in both STEMI and NSTE-ACS," the authors write.
Two authors disclosed financial ties to the pharmaceutical industry.
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