Advanced

Diabetic patients with acute coronary syndromes in contemporary European registries : Characteristics and outcomes

Lettino, Maddalena; Andell, Pontus LU ; Zeymer, Uwe; Widimsky, Petr; Danchin, Nicolas; Bardaji, Alfredo; Barrabes, Jose A.; Cequier, Angel; Claeys, Marc J. and De Luca, Leonardo, et al. (2017) In European Heart Journal - Cardiovascular Pharmacotherapy 3(4). p.198-213
Abstract

Aims Among patients with acute coronary syndromes (ACS), those with diabetes mellitus (DM) are at particularly high risk of recurrent cardiovascular events and premature death. We aimed to provide a descriptive overview of unadjusted analyses of patient characteristics, ACS management, and outcomes up to 1 year after hospital admission for an ACS/index-ACS event, in patients with DM in contemporary registries in Europe. Methods and results A total of 10 registries provided data in a systematic manner on ACS patients with DM (total n =28 899), and without DM (total n= 97 505). In the DM population, the proportion of patients with ST-Segment Elevation Myocardial Infarction (STEMI) ranged from 22.1% to 64.6% (other patients had... (More)

Aims Among patients with acute coronary syndromes (ACS), those with diabetes mellitus (DM) are at particularly high risk of recurrent cardiovascular events and premature death. We aimed to provide a descriptive overview of unadjusted analyses of patient characteristics, ACS management, and outcomes up to 1 year after hospital admission for an ACS/index-ACS event, in patients with DM in contemporary registries in Europe. Methods and results A total of 10 registries provided data in a systematic manner on ACS patients with DM (total n =28 899), and without DM (total n= 97 505). In the DM population, the proportion of patients with ST-Segment Elevation Myocardial Infarction (STEMI) ranged from 22.1% to 64.6% (other patients had non-ST-Segment Elevation Myocardial Infarction (NSTEMI-ACS) or unstable angina). All-cause mortality in the registries ranged from 1.4% to 9.4% in-hospital; 2.8% to 7.9% at 30 days post-discharge; 5.1% to 10.7% at 180 days post-discharge; and 3.3% to 10.5% at 1 year post-discharge. Major bleeding events were reported in up to 3.8% of patients while in hospital (8 registries); up to 1.3% at 30 days (data from two registries only), and 2.0% at 1 year (one registry only). Registries differed substantially in terms of study setting, site, patient selection, definition and schedule of endpoints, and use of various P2Y12 inhibitors. In most, but not all, registries, event rates in DM patients were higher than in patients without DM. Pooled risk ratios comparing cohorts with DM vs. no DM were in-hospital significantly higher in DM for all-cause death (1.66; 95% CI 1.42-1.94), for cardiovascular death (2.33; 1.78 - 3.03), and for major bleeding (1.35; 1.21-1.52). Conclusion These registry data from real-life clinical practice confirm a high risk for recurrent events among DM patients with ACS, with great variation across the different registries.

(Less)
Please use this url to cite or link to this publication:
author
, et al. (More)
(Less)
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Acute coronary syndromes, Antiplatelets, Clopidogrel, Diabetes mellitus, Non-ST-segment elevation, Observational, P2Y12 receptor inhibitors, Prasugrel, ST-segment elevation, Ticagrelor, Type 2 diabetes, Unstable angina
in
European Heart Journal - Cardiovascular Pharmacotherapy
volume
3
issue
4
pages
198 - 213
publisher
Oxford University Press
external identifiers
  • scopus:85030872719
ISSN
2055-6837
DOI
10.1093/ehjcvp/pvw049
language
English
LU publication?
yes
id
04d2dcf7-6fab-4ab7-9f9d-7bf7b0a175ff
date added to LUP
2019-05-23 10:39:37
date last changed
2019-11-05 05:19:57
@article{04d2dcf7-6fab-4ab7-9f9d-7bf7b0a175ff,
  abstract     = {<p>Aims Among patients with acute coronary syndromes (ACS), those with diabetes mellitus (DM) are at particularly high risk of recurrent cardiovascular events and premature death. We aimed to provide a descriptive overview of unadjusted analyses of patient characteristics, ACS management, and outcomes up to 1 year after hospital admission for an ACS/index-ACS event, in patients with DM in contemporary registries in Europe. Methods and results A total of 10 registries provided data in a systematic manner on ACS patients with DM (total n =28 899), and without DM (total n= 97 505). In the DM population, the proportion of patients with ST-Segment Elevation Myocardial Infarction (STEMI) ranged from 22.1% to 64.6% (other patients had non-ST-Segment Elevation Myocardial Infarction (NSTEMI-ACS) or unstable angina). All-cause mortality in the registries ranged from 1.4% to 9.4% in-hospital; 2.8% to 7.9% at 30 days post-discharge; 5.1% to 10.7% at 180 days post-discharge; and 3.3% to 10.5% at 1 year post-discharge. Major bleeding events were reported in up to 3.8% of patients while in hospital (8 registries); up to 1.3% at 30 days (data from two registries only), and 2.0% at 1 year (one registry only). Registries differed substantially in terms of study setting, site, patient selection, definition and schedule of endpoints, and use of various P2Y12 inhibitors. In most, but not all, registries, event rates in DM patients were higher than in patients without DM. Pooled risk ratios comparing cohorts with DM vs. no DM were in-hospital significantly higher in DM for all-cause death (1.66; 95% CI 1.42-1.94), for cardiovascular death (2.33; 1.78 - 3.03), and for major bleeding (1.35; 1.21-1.52). Conclusion These registry data from real-life clinical practice confirm a high risk for recurrent events among DM patients with ACS, with great variation across the different registries.</p>},
  author       = {Lettino, Maddalena and Andell, Pontus and Zeymer, Uwe and Widimsky, Petr and Danchin, Nicolas and Bardaji, Alfredo and Barrabes, Jose A. and Cequier, Angel and Claeys, Marc J. and De Luca, Leonardo and Dörler, Jakob and Erlinge, David and Erne, Paul and Goldstein, Patrick and Koul, Sasha M. and Lemesle, Gilles and Lüscher, Thomas F. and Matter, Christian M. and Montalescot, Gilles and Radovanovic, Dragana and Sendón, Jose Lopez and Tousek, Petr and Weidinger, Franz and Weston, Clive F.M. and Zaman, Azfar and Li, Jin and Jukema, J. Wouter},
  issn         = {2055-6837},
  keyword      = {Acute coronary syndromes,Antiplatelets,Clopidogrel,Diabetes mellitus,Non-ST-segment elevation,Observational,P2Y12 receptor inhibitors,Prasugrel,ST-segment elevation,Ticagrelor,Type 2 diabetes,Unstable angina},
  language     = {eng},
  month        = {10},
  number       = {4},
  pages        = {198--213},
  publisher    = {Oxford University Press},
  series       = {European Heart Journal - Cardiovascular Pharmacotherapy},
  title        = {Diabetic patients with acute coronary syndromes in contemporary European registries : Characteristics and outcomes},
  url          = {http://dx.doi.org/10.1093/ehjcvp/pvw049},
  volume       = {3},
  year         = {2017},
}