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Diabetes and mortality following acute coronary syndromes.
JAMA. 2007 Aug 15; 298(7):765-75.JAMA

Abstract

CONTEXT

The worldwide epidemic of diabetes mellitus is increasing the burden of cardiovascular disease, the leading cause of death among persons with diabetes. The independent effect of diabetes on mortality following acute coronary syndromes (ACS) is uncertain.

OBJECTIVE

To evaluate the influence of diabetes on mortality following ACS using a large database spanning the full spectrum of ACS.

DESIGN, SETTING, AND PATIENTS

A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI] and 15,459 with unstable angina/non-STEMI [UA/NSTEMI]), of whom 10 613 (17.1%) had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event.

MAIN OUTCOME MEASURES

Mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes.

RESULTS

Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI (2.1% vs 1.1%, P < .001) and STEMI (8.5% vs 5.4%, P < .001). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.24-2.56) or STEMI (OR, 1.40; 95% CI, 1.24-1.57). Diabetes at presentation with ACS was associated with significantly higher mortality 1 year after UA/NSTEMI (hazard ratio [HR], 1.65; 95% CI, 1.30-2.10) or STEMI (HR, 1.22; 95% CI, 1.08-1.38). By 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2% vs 8.1%).

CONCLUSION

Despite modern therapies for ACS, diabetes confers a significant adverse prognosis, which highlights the importance of aggressive strategies to manage this high-risk population with unstable ischemic heart disease.

Authors+Show Affiliations

Department of Medicine, Division of Cardiology, Cornell University Medical Center, New York, New York, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

17699010

Citation

Donahoe, Sean M., et al. "Diabetes and Mortality Following Acute Coronary Syndromes." JAMA, vol. 298, no. 7, 2007, pp. 765-75.
Donahoe SM, Stewart GC, McCabe CH, et al. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298(7):765-75.
Donahoe, S. M., Stewart, G. C., McCabe, C. H., Mohanavelu, S., Murphy, S. A., Cannon, C. P., & Antman, E. M. (2007). Diabetes and mortality following acute coronary syndromes. JAMA, 298(7), 765-75.
Donahoe SM, et al. Diabetes and Mortality Following Acute Coronary Syndromes. JAMA. 2007 Aug 15;298(7):765-75. PubMed PMID: 17699010.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Diabetes and mortality following acute coronary syndromes. AU - Donahoe,Sean M, AU - Stewart,Garrick C, AU - McCabe,Carolyn H, AU - Mohanavelu,Satishkumar, AU - Murphy,Sabina A, AU - Cannon,Christopher P, AU - Antman,Elliott M, PY - 2007/8/21/pubmed PY - 2007/8/21/medline PY - 2007/8/21/entrez SP - 765 EP - 75 JF - JAMA JO - JAMA VL - 298 IS - 7 N2 - CONTEXT: The worldwide epidemic of diabetes mellitus is increasing the burden of cardiovascular disease, the leading cause of death among persons with diabetes. The independent effect of diabetes on mortality following acute coronary syndromes (ACS) is uncertain. OBJECTIVE: To evaluate the influence of diabetes on mortality following ACS using a large database spanning the full spectrum of ACS. DESIGN, SETTING, AND PATIENTS: A subgroup analysis of patients with diabetes enrolled in randomized clinical trials that evaluated ACS therapies. Patients with ACS in 11 independent Thrombolysis in Myocardial Infarction (TIMI) Study Group clinical trials from 1997 to 2006 were pooled, including 62,036 patients (46,577 with ST-segment elevation myocardial infarction [STEMI] and 15,459 with unstable angina/non-STEMI [UA/NSTEMI]), of whom 10 613 (17.1%) had diabetes. A multivariable model was constructed to adjust for baseline characteristics, aspects of ACS presentation, and treatments for the ACS event. MAIN OUTCOME MEASURES: Mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes. RESULTS: Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI (2.1% vs 1.1%, P < .001) and STEMI (8.5% vs 5.4%, P < .001). After adjusting for baseline characteristics and features and management of the ACS event, diabetes was independently associated with higher 30-day mortality after UA/NSTEMI (odds ratio [OR], 1.78; 95% confidence interval [CI], 1.24-2.56) or STEMI (OR, 1.40; 95% CI, 1.24-1.57). Diabetes at presentation with ACS was associated with significantly higher mortality 1 year after UA/NSTEMI (hazard ratio [HR], 1.65; 95% CI, 1.30-2.10) or STEMI (HR, 1.22; 95% CI, 1.08-1.38). By 1 year following ACS, patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI (7.2% vs 8.1%). CONCLUSION: Despite modern therapies for ACS, diabetes confers a significant adverse prognosis, which highlights the importance of aggressive strategies to manage this high-risk population with unstable ischemic heart disease. SN - 1538-3598 UR - https://www.unboundmedicine.com/medline/citation/17699010/Diabetes_and_mortality_following_acute_coronary_syndromes_ L2 - https://jamanetwork.com/journals/jama/fullarticle/10.1001/jama.298.7.765 DB - PRIME DP - Unbound Medicine ER -