Polskie Archiwum Medycyny Wewnetrznej · 2004
[12-month outcomes of diabetic and non-diabetic patients with acute coronary syndromes assigned to early invasive treatment strategy].
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Szyguła-Jurkiewicz Bozena, Wilczek Krzysztof, Osuch Marcin, Poloński Lech
Аннотация
INTRODUCTION: Epidemiological studies show that diabetes mellitus is a serious medical, economic and public health problem. 21-30% of patients with acute coronary syndromes (ACS) have diabetes. We aimed at assessing the in-hospital and 12-month outcomes of diabetic and non-diabetic patients with ACS without ST-segment elevation.
METHODS: 329 consecutive patients with ACS without ST-segment elevation were entered into the study, of whom 63 patients (19.1%) had diabetes mellitus. The inclusion criteria were: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (< 20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or = 0.1 mV) in at least 2 continuous leads, positive serum cardiac markers. All patients underwent coronary angiography and percutaneous coronary intervention (PCI) within the first 24 hours of admission.
RESULTS: Baseline profiles were similar in both groups. More non-diabetic patients had initial TIMI 3 flow (76% vs 65%, p = 0.05), whereas the rate of successful PCI (final TIMI 3 flow) was similar in both groups (97.7% vs 96.8%, NS). The rate of GP IIb/IIIa inhibitors treatment was similar in both groups. Overall mortality in the diabetic group and in the non-diabetic group was 7.9% and 3.4% respectively (NS). In-hospital mortality rate was 3.2% and 1.1% respectively (NS). After discharge, 9 patients died, of whom 3 patients were in the diabetic group and 6 patients in the non-diabetic group (5.0% vs 2.28% NS). The rate of MI during follow-up was similar in both groups. More diabetic patients had episodes of unstable angina during follow-up (30% vs 17.9%, p = 0.034). Primary endpoint (death, myocardial infarction, repeat revascularization) was more frequent in the diabetic patients (28.57% vs 17.67%, p = 0.05), whereas the rate of combined endpoint (death, myocardial infarction, repeat revascularization, cardiovascular hospitalization) was similar in both groups (40% vs 26.23%, NS). More diabetic patients received beta-blockers, diuretics and digoxin during follow-up.
CONCLUSIONS: Early invasive treatment and intensive medical therapy improves in-hospital prognosis for diabetic patients, whereas diabetes mellitus affects long-term outcomes with more episodes of unstable angina and a more frequent rate of repeat revascularization.
METHODS: 329 consecutive patients with ACS without ST-segment elevation were entered into the study, of whom 63 patients (19.1%) had diabetes mellitus. The inclusion criteria were: 1) rest angina within 24 hours prior to admission, 2) at least one of the following: ST-segment depression (> or = 0.05 mV), transient (< 20 min) ST-segment elevation (> or = 0.05 mV), T-wave inversion (> or = 0.1 mV) in at least 2 continuous leads, positive serum cardiac markers. All patients underwent coronary angiography and percutaneous coronary intervention (PCI) within the first 24 hours of admission.
RESULTS: Baseline profiles were similar in both groups. More non-diabetic patients had initial TIMI 3 flow (76% vs 65%, p = 0.05), whereas the rate of successful PCI (final TIMI 3 flow) was similar in both groups (97.7% vs 96.8%, NS). The rate of GP IIb/IIIa inhibitors treatment was similar in both groups. Overall mortality in the diabetic group and in the non-diabetic group was 7.9% and 3.4% respectively (NS). In-hospital mortality rate was 3.2% and 1.1% respectively (NS). After discharge, 9 patients died, of whom 3 patients were in the diabetic group and 6 patients in the non-diabetic group (5.0% vs 2.28% NS). The rate of MI during follow-up was similar in both groups. More diabetic patients had episodes of unstable angina during follow-up (30% vs 17.9%, p = 0.034). Primary endpoint (death, myocardial infarction, repeat revascularization) was more frequent in the diabetic patients (28.57% vs 17.67%, p = 0.05), whereas the rate of combined endpoint (death, myocardial infarction, repeat revascularization, cardiovascular hospitalization) was similar in both groups (40% vs 26.23%, NS). More diabetic patients received beta-blockers, diuretics and digoxin during follow-up.
CONCLUSIONS: Early invasive treatment and intensive medical therapy improves in-hospital prognosis for diabetic patients, whereas diabetes mellitus affects long-term outcomes with more episodes of unstable angina and a more frequent rate of repeat revascularization.