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Scudeler TL, Godoy LC, Hoxha T, Kung A, Moreno PR, Farkouh ME. Revascularization Strategies in Patients with Diabetes and Acute Coronary Syndromes. Curr Cardiol Rep 2022; 24:201-208. [PMID: 35089503 DOI: 10.1007/s11886-022-01646-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/26/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE OF REVIEW To review the current evidence for coronary revascularization in patients with diabetes mellitus (DM) in the setting of an acute coronary syndrome (ACS). RECENT FINDINGS In patients with DM and stable multivessel ischemic heart disease, coronary artery bypass graft surgery (CABG) has been observed to be superior to percutaneous coronary intervention (PCI) in long-term follow-up, leading to lower rates of all-cause mortality, myocardial infarction, and repeat revascularization. In the ACS setting, PCI remains the most frequently performed procedure. In patients with an ST-segment-elevation myocardial infarction (STEMI), primary PCI should be the revascularization method of choice, whenever feasible. Controversy still exists regarding when and how to deal with possible residual lesions. In the non-ST-segment-elevation (NSTE) ACS setting, although there are no data from randomized controlled trials (RCTs), recent observational data and sub-analyses of randomized studies have suggested that CABG may be the preferred approach for patients with DM and multivessel coronary disease. There is a paucity of RCTs evaluating revascularization strategies (PCI and CABG) in patients with DM and ACS. CABG may be a viable strategy, leading to improved outcomes, especially following NSTE-ACS.
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Affiliation(s)
- Thiago L Scudeler
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Lucas C Godoy
- Instituto do Coração (InCor), Hospital das Clínicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil.,Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada
| | - Tedi Hoxha
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada.,Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Andrew Kung
- American University of the Caribbean School of Medicine, St. Maarten, US
| | - Pedro R Moreno
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, US
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Canada.
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Are there sex differences in the effect of type 2 diabetes in the incidence and outcomes of myocardial infarction? A matched-pair analysis using hospital discharge data. Cardiovasc Diabetol 2021; 20:81. [PMID: 33888124 PMCID: PMC8063379 DOI: 10.1186/s12933-021-01273-y] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 04/15/2021] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND To analyze incidence, use of therapeutic procedures, and in-hospital outcomes in patients with ST elevation myocardial infarction (STEMI) and non-ST elevation myocardial infarction (NSTEMI) according to the presence of type 2 diabetes (T2DM) in Spain (2016-2018) and to investigate sex differences. METHODS Using the Spanish National Hospital Discharge Database, we estimated the incidence of myocardial infarctions (MI) in men and women with and without T2DM aged ≥ 40 years. We analyzed comorbidity, procedures, and outcomes. We matched each man and woman with T2DM with a non-T2DM man and woman of identical age, MI code, and year of hospitalization. Propensity score matching was used to compare men and women with T2DM. RESULTS MI was coded in 109,759 men and 44,589 women (30.47% with T2DM). The adjusted incidence of STEMI (IRR 2.32; 95% CI 2.28-2.36) and NSTEMI (IRR 2.91; 95% CI 2.88-2.94) was higher in T2DM than non-T2DM patients, with higher IRRs for NSTEMI in both sexes. The incidence of STEMI and NSTEMI was higher in men with T2DM than in women with T2DM. After matching, percutaneous coronary intervention (PCI) was less frequent among T2DM men than non-T2DM men who had STEMI and NSTEMI. Women with T2DM and STEMI less frequently had a code for PCI that matched that of non-T2DM women. In-hospital mortality (IHM) was higher among T2DM women with STEMI and NSTEMI than in matched non-T2DM women. In men, IHM was higher only for NSTEMI. Propensity score matching showed higher use of PCI and coronary artery bypass graft and lower IHM among men with T2DM than women with T2DM for both STEMI and NSTEMI. CONCLUSIONS T2DM is associated with a higher incidence of STEMI and NSTEMI in both sexes. Men with T2DM had higher incidence rates of STEMI and NSTEMI than women with T2DM. Having T2DM increased the risk of IHM after STEMI and NSTEMI among women and among men only for NSTEMI. PCI appears to be less frequently used in T2DM patients After STEMI and NSTEMI, women with T2DM less frequently undergo revascularization procedures and have a higher mortality risk than T2DM men.
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Brantnell A, Woodford J, Baraldi E, van Achterberg T, von Essen L. Views of Implementers and Nonimplementers of Internet-Administered Cognitive Behavioral Therapy for Depression and Anxiety: Survey of Primary Care Decision Makers in Sweden. J Med Internet Res 2020; 22:e18033. [PMID: 32784186 PMCID: PMC7450364 DOI: 10.2196/18033] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 05/11/2020] [Accepted: 05/13/2020] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Internet-administered cognitive behavioral therapy (ICBT) has been demonstrated to be an effective intervention for adults with depression and/or anxiety and is recommended in national guidelines for provision within Swedish primary care. However, the number and type of organizations that have implemented ICBT within primary care in Sweden is currently unclear. Further, there is a lack of knowledge concerning barriers and facilitators to ICBT implementation. OBJECTIVE The two primary objectives were to identify and describe primary care organizations providing ICBT in Sweden and compare decision makers' (ie, directors of primary care organizations) views on barriers and facilitators to implementation of ICBT among ICBT implementers (ie, organizations that offered ICBT) and nonimplementers (ie, organizations that did not offer ICBT). METHODS An online survey based on a checklist for identifying barriers and facilitators to implementation was developed and made accessible to decision makers from all primary care organizations in Sweden. The survey consisted of background questions (eg, provision of ICBT and number of persons working with ICBT) and barriers and facilitators relating to the following categories: users, therapists, ICBT programs, organizations, and wider society. RESULTS The participation rate was 35.75% (404/1130). The majority (250/404, 61.8%) of participants were health care center directors and had backgrounds in nursing. Altogether, 89.8% (363/404) of the participating organizations provided CBT. A minority (83/404, 20.5%) of organizations offered ICBT. Most professionals delivering ICBT were psychologists (67/83, 80%) and social workers (31/83, 37%). The majority (61/83, 73%) of organizations had 1 to 2 persons delivering ICBT interventions. The number of patients treated with ICBT during the last 12 months was 1 to 10 in 65% (54/83) of the organizations, ranging between 1 and 400 treated patients across the whole sample. There were 9 significant (P<.05) differences out of 37 possible between implementers and nonimplementers. For example, more implementers (48/51, 94%) than nonimplementers (107/139, 76.9%) perceived few technical problems (P<.001), and more implementers (53/77, 68%) than nonimplementers (103/215, 47.9%) considered that their organization has resources to offer ICBT programs (P<.001). CONCLUSIONS Despite research demonstrating the effectiveness of ICBT for depression and anxiety and national guidelines recommending its use, ICBT is implemented in few primary care organizations in Sweden. Several interesting differences between implementers and nonimplementers were identified, which may help inform interventions focusing on facilitating the implementation of ICBT.
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Affiliation(s)
- Anders Brantnell
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden.,Division of Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Joanne Woodford
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Enrico Baraldi
- Division of Industrial Engineering and Management, Department of Civil and Industrial Engineering, Uppsala University, Uppsala, Sweden
| | - Theo van Achterberg
- KU Leuven, Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, Leuven, Belgium
| | - Louise von Essen
- Clinical Psychology in Healthcare, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
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Wang CL, Chen PC, Juang HT, Chang CJ. Adverse Outcomes Associated with Pre-Existing and New-Onset Atrial Fibrillation in Patients with Acute Coronary Syndrome: A Retrospective Cohort Study. Cardiol Ther 2019; 8:117-127. [PMID: 30997660 PMCID: PMC6525230 DOI: 10.1007/s40119-019-0136-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2018] [Indexed: 12/12/2022] Open
Abstract
Introduction Atrial fibrillation (AF) often occurs in patients with acute coronary syndrome (ACS). It remains unclear whether pre-existing or new-onset AF confers different risk in patients with ACS. Methods We conducted a retrospective cohort study using Taiwan’s National Health Insurance Research Database. Patients who were hospitalized with a primary diagnosis of ACS from 2005 to 2009 were studied. Major outcomes were mortality, heart failure, and combined ischemic stroke/systemic embolism (IS/SE). The date of the first ACS diagnosis was defined as the index date. Pre-existing AF was defined as AF occurring before the index date. New-onset AF was defined as AF that started after or at the same time as the ACS diagnosis. Results Among 6663 patients with ACS, 488 (7.3%) had pre-existing AF and 479 (7.2%) had new-onset AF. Compared to patients with pre-existing AF, those with new-onset AF were younger, less likely to have co-morbidities, and more likely to receive evidence-based therapy. The un-adjusted risks of adverse outcomes in both groups were similar. Compared to pre-existing AF, new-onset AF was significantly associated with a higher adjusted risk of death (hazard ratio 1.27, 95% confidence interval 1.06–1.52) and IS/SE (hazard ratio 1.49, 95% confidence interval 1.01–2.20). The significant associations between new-onset AF and adverse outcomes were more likely to be observed in elderly patients with ACS. Conclusions New-onset AF during ACS was associated with a significantly increased risk of adverse outcomes, especially in the elderly patients.
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Affiliation(s)
- Chun-Li Wang
- Cardiovascular Department, Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pei-Chun Chen
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan.,Department of Public Health, China Medical University, Taizhong, Taiwan
| | - Hsiao-Ting Juang
- Clinical Informatics and Medical Statistics Research Center, Chang Gung University College of Medicine, Taoyuan, Taiwan
| | - Chee-Jen Chang
- Cardiovascular Department, Internal Medicine, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Research Services Center for Health Information, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medicine, Chang Gung University, Taoyuan, Taiwan.
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5
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Godoy LC, Lawler PR, Farkouh ME, Hersen B, Nicolau JC, Rao V. Urgent Revascularization Strategies in Patients With Diabetes Mellitus and Acute Coronary Syndrome. Can J Cardiol 2019; 35:993-1001. [PMID: 31376910 DOI: 10.1016/j.cjca.2019.03.010] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Revised: 03/11/2019] [Accepted: 03/12/2019] [Indexed: 02/01/2023] Open
Abstract
The prevalence of diabetes mellitus (DM) is rising globally and in Canada. Besides being a risk factor for the development of coronary artery disease, DM is also a marker of poor prognosis in patients with acute coronary syndrome (ACS), increasing the risks for ischemic and bleeding complications. Patients with DM have a high prevalence of multivessel coronary artery disease (MVD) and robust evidence has supported coronary artery bypass surgery (CABG) as the optimal revascularization strategy in the setting of stable ischemic heart disease. In the acute scenario, particularly in patients with non-ST-segment elevation (NSTE) ACS (NSTE-ACS), there are many uncertainties regarding the best revascularization strategy. Most guidelines suggest an invasive and timely approach (that is, performing coronary catheterization within 72 hours after the onset of the NSTE-ACS) and make recommendations about choosing between percutaneous coronary intervention (PCI) or CABG on the basis of data for patients with stable ischemic heart disease. Recent observational and subgroup analyses suggest that CABG might be the preferential method of revascularization for patients with DM and MVD also in the NSTE-ACS setting; however, dedicated randomized clinical trials are lacking. Finally, in patients who present with an ST-segment elevation myocardial infarction, the initial revascularization method of choice is generally PCI, instead of fibrinolysis or CABG, and DM status most often does not influence this decision. The management of residual MVD after primary PCI for ST-segment elevation myocardial infarction, however, remains controversial.
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Affiliation(s)
- Lucas C Godoy
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada; Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Patrick R Lawler
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | - Michael E Farkouh
- Peter Munk Cardiac Centre and Heart and Stroke Richard Lewar Centre, University of Toronto, Toronto, Ontario, Canada
| | | | - José C Nicolau
- Instituto do Coracao (InCor), Faculdade de Medicina FMUSP, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Vivek Rao
- Peter Munk Cardiac Centre and Toronto General Research Institute, Division of Cardiovascular Surgery, Toronto General Hospital, University of Toronto, Toronto, Ontario, Canada.
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Mohr GH, Søndergaard KB, Pallisgaard JL, Møller SG, Wissenberg M, Karlsson L, Hansen SM, Kragholm K, Køber L, Lippert F, Folke F, Vilsbøll T, Torp-Pedersen C, Gislason G, Rajan S. Survival of patients with and without diabetes following out-of-hospital cardiac arrest: A nationwide Danish study. EUROPEAN HEART JOURNAL-ACUTE CARDIOVASCULAR CARE 2019; 9:599-607. [PMID: 30632777 DOI: 10.1177/2048872618823349] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Research regarding out-of-hospital cardiac arrest (OHCA) survival of diabetes patients is sparse and it remains unknown whether initiatives to increase OHCA survival benefit diabetes and non-diabetes patients equally. We therefore examined overall and temporal survival in diabetes and non-diabetes patients following OHCA. METHODS Adult presumed cardiac-caused OHCAs were identified from the Danish Cardiac Arrest Registry (2001-2014). Associations between diabetes and return of spontaneous circulation upon hospital arrival and 30-day survival were estimated with logistic regression adjusted for patient- and OHCA-related characteristics. RESULTS In total, 28,955 OHCAs were included of which 4276 (14.8%) had diabetes. Compared with non-diabetes patients, diabetes patients had more comorbidities, same prevalence of bystander-witnessed arrests (51.7% vs. 52.7%) and bystander cardiopulmonary resuscitation (43.2% vs. 42.0%), more arrests in residential locations (77.3% vs. 73.0%) and were less likely to have shockable heart rhythm (23.5% vs. 27.9%). Temporal increases in return of spontaneous circulation and 30-day survival were seen for both groups (return of spontaneous circulation: 8.8% in 2001 to 22.3% in 2014 (diabetes patients) vs. 7.8% in 2001 to 25.7% in 2014 (non-diabetes patients); and 30-day survival: 2.8% in 2001 to 9.7% in 2014 vs. 3.5% to 14.8% in 2014, respectively). In adjusted models, diabetes was associated with decreased odds of return of spontaneous circulation (odds ratio 0.74 (95% confidence interval 0.66-0.82)) and 30-day survival (odds ratio 0.56 (95% confidence interval 0.48-0.65)) (interaction with calendar year p=0.434 and p=0.243, respectively). CONCLUSION No significant difference in temporal survival was found between the two groups. However, diabetes was associated with lower odds of return of spontaneous circulation and 30-day survival.
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Affiliation(s)
- Grímur Høgnason Mohr
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Kathrine B Søndergaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Jannik L Pallisgaard
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Sidsel Gamborg Møller
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
| | - Mads Wissenberg
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Lena Karlsson
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Steen Møller Hansen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark
| | - Kristian Kragholm
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Hjørring Regional Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark
| | - Lars Køber
- The Heart Centre, Rigshospitalet, University of Copenhagen, Denmark
| | - Freddy Lippert
- Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Fredrik Folke
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Emergency Medical Services Copenhagen, University of Copenhagen, Denmark
| | - Tina Vilsbøll
- Clinical Metabolic Physiology, Steno Diabetes Centre Copenhagen, University of Copenhagen, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark
| | - Christian Torp-Pedersen
- Unit of Epidemiology and Biostatistics, Aalborg University Hospital, Denmark.,Department of Cardiology, Aalborg University Hospital, Denmark.,Department of Health Science and Technology, Aalborg University, Denmark
| | - Gunnar Gislason
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.,National Institute of Public Health, University of Southern Denmark, Copenhagen, Denmark.,The Danish Heart Foundation, Copenhagen, Denmark
| | - Shahzleen Rajan
- Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Gentofte, Denmark
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8
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Lettino M, Andell P, Zeymer U, Widimsky P, Danchin N, Bardaji A, Barrabes JA, Cequier A, Claeys MJ, De Luca L, Dörler J, Erlinge D, Erne P, Goldstein P, Koul SM, Lemesle G, Lüscher TF, Matter CM, Montalescot G, Radovanovic D, Sendón JL, Tousek P, Weidinger F, Weston CFM, Zaman A, Li J, Jukema JW. Diabetic patients with acute coronary syndromes in contemporary European registries: characteristics and outcomes. EUROPEAN HEART JOURNAL. CARDIOVASCULAR PHARMACOTHERAPY 2017; 3:198-213. [PMID: 28329196 DOI: 10.1093/ehjcvp/pvw049] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 12/23/2016] [Indexed: 02/06/2023]
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 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.
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Affiliation(s)
- Maddalena Lettino
- Cardiology Unit, Humanitas Research Hospital, Rozzano (Milano), Italy
| | - Pontus Andell
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Uwe Zeymer
- Klinikum Ludwigshafen and Institut für Herzinfarktforschung, Ludwigshafen, Germany
| | - Petr Widimsky
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Nicolas Danchin
- Department of Cardiology, Hospital Européen Georges Pompidou and Université Paris Descartes, Paris, France
| | - Alfredo Bardaji
- Institut d'Investigació Sanitària Pere Virgili, Cardiology Service, Hospital Universitari de Tarragona Joan XXIII, Tarragona, Spain
| | - Jose A Barrabes
- Cardiology Service, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Angel Cequier
- Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute (IDIBELL), University of Barcelona, Barcelona, Spain
| | - Marc J Claeys
- Department of Cardiology, University Hospital Antwerp, Edegem, Belgium
| | - Leonardo De Luca
- Department of Cardiovascular Sciences, Laboratory of Interventional Cardiology, European Hospital, Rome, Italy
| | - Jakob Dörler
- University Clinic of Internal Medicine III, Cardiology and Angiology, Medical University of Innsbruck, Innsbruck, Austria
| | - David Erlinge
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Paul Erne
- AMIS-Plus Data Center, University of Zurich, Zurich, Switzerland
| | - Patrick Goldstein
- Pôle de L'urgence, Service de d'Aide Médicale Urgente du Nord, Centre Hospitalier Régional, Universitaire de Lille, Lille, France
| | - Sasha M Koul
- Department of Cardiology, Clinical Sciences, Lund University, Skåne University Hospital, Lund, Sweden
| | - Gilles Lemesle
- Cardiac Intensive Care Unit, Interventional Cardiology Hospital Cardiologique, Centre Hospitalier Régional et Universitaire de Lille, Lille, France
| | - Thomas F Lüscher
- Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Christian M Matter
- Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Gilles Montalescot
- Université Paris 06, ACTION Study Group, INSERM-UMRS 1166, Institut de Cardiologie, Pitié-Salpêtrière University Hospital (AP-HP), Paris, France
| | - Dragana Radovanovic
- AMIS Plus Data Center, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | | | - Petr Tousek
- Cardiocenter, Third Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Franz Weidinger
- 2nd Department of Medicine with Cardiology and Intensive Care, Hospital Rudolfstiftung, Vienna, Austria
| | | | - Azfar Zaman
- Cardiology, Freeman Hospital and Institute of Cellular Medicine, Newcastle-upon, Tyne, UK
| | - Jin Li
- Cardiology Department, University Heart Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - J Wouter Jukema
- Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
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Mahmoud AN, Elgendy IY, Mansoor H, Wen X, Mojadidi MK, Bavry AA, Anderson RD. Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-ST-Elevation Acute Coronary Syndromes: A Contemporary National Insight. J Am Heart Assoc 2017; 6:JAHA.116.005369. [PMID: 28315826 PMCID: PMC5524040 DOI: 10.1161/jaha.116.005369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Background There are limited data on the merits of an early invasive strategy in diabetics with non‐ST‐elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in‐hospital survival of diabetics with non‐ST‐elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. Methods and Results The National Inpatient Sample database, years 2012–2013, was queried for diabetics with a primary diagnosis of non‐ST‐elevation acute coronary syndrome defined as either non‐ST‐elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in‐hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non‐ST‐elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in‐hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39–0.42; P<0.0001) and propensity‐matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50–0.63; P<0.0001). The benefit was observed across various subgroups, except for patients with unstable angina (Pinteraction=0.02). Conclusions An early invasive strategy may be associated with a lower incidence of in‐hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non‐ST‐elevation myocardial infarction compared with unstable angina.
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Affiliation(s)
- Ahmed N Mahmoud
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Islam Y Elgendy
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Hend Mansoor
- Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL
| | - Xuerong Wen
- College of Pharmacy, University of Rhode Island, Kingston, RI
| | - Mohammad K Mojadidi
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
| | - Anthony A Bavry
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.,Cardiology Section (111D), North Florida/South Georgia Veterans Health System Malcom Randall Veterans Administration Medical Center Medical Service, Gainesville, FL
| | - R David Anderson
- Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL
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10
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Awad HH, Tisminetzky M, Metry D, McManus D, Yarzebski J, Gore JM, Goldberg RJ. Magnitude, treatment, and impact of diabetes mellitus in patients hospitalized with non-ST segment elevation myocardial infarction: A community-based study. Diab Vasc Dis Res 2016; 13:13-20. [PMID: 26499915 PMCID: PMC4816073 DOI: 10.1177/1479164115609027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE OF THE STUDY To examine differences in the characteristics, treatment practices and in-hospital outcomes of patients with and without previously diagnosed diabetes hospitalized for non-ST segment elevation myocardial infarction. KEY METHODS The study cohort consisted of 3916 patients diagnosed with non-ST segment elevation myocardial infarction at all 11 central MA medical centres between 1999 and 2009, of whom 1475 (38%) had been previously diagnosed with diabetes. MAIN RESULTS Diabetic patients were more likely to have received treatment with effective cardiac medications, and to have undergone coronary bypass surgery, but were less likely to have received a percutaneous coronary intervention, than non-diabetic patients. Patients with a history of diabetes were more likely to have developed cardiogenic shock, heart failure and died during their index hospitalization than non-diabetic patients. MAIN CONCLUSION Diabetic patients presenting with non-ST segment elevation myocardial infarction remain at high risk of developing significant clinical complications during hospitalization.
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Affiliation(s)
- Hamza H Awad
- Department of Community Medicine/Department of Internal Medicine, Mercer University School of Medicine, Macon, GA, USA
| | - Mayra Tisminetzky
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Diana Metry
- Children's Healthcare of Atlanta, Emory University, Atlanta, GA, USA
| | - David McManus
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jorge Yarzebski
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Joel M Gore
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA Division of Cardiovascular Medicine, University of Massachusetts Medical School, Worcester, MA, USA
| | - Robert J Goldberg
- Division of Epidemiology of Chronic Diseases and Vulnerable Populations, Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
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