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.
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Article Info
Publication History
Published online: May 14, 2016
Accepted:
May 4,
2016
Received in revised form:
May 4,
2016
Received:
March 10,
2016
Footnotes
See page 351 for disclosure information.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
