Clinical InvestigationAcute Ischemic Heart DiseaseUnderuse of evidence-based treatment partly explains the worse clinical outcome in diabetic patients with acute coronary syndromes
Section snippets
Research design and study population
The Canadian ACS Registry was a prospective, multicenter, observational study designed to examine the epidemiology, the in-hospital and post-discharge management, and the outcome of less selected patients with ACS. A detailed description of patients and methods has been published previously.9
In brief, patients older than 18 years admitted to the hospital with a suspected diagnosis of ACS (defined by symptoms consistent with acute cardiac ischemia with onset less than 24 hours and not
Patient characteristics
A total of 5312 patients were enrolled in the ACS registry. This analysis focuses exclusively on the 4578 subjects with confirmed ACS (86.2% of enrollment) as adjudicated by the final diagnosis of unstable angina (n = 1787) or MI (n = 2791). Of these ACS patients, 1685 (36.8%) presented with ST-elevation ACS and 1149 (25.1%) had diabetes. Their pertinent baseline characteristics and differences in clinical presentation according to diabetic status are summarized in Table I.
In-hospital management
Differences in the
Discussions
This multicenter observational study of ACS patients in the real world demonstrated substantial diabetes-related differences in patient characteristics, treatment, and outcome. Our results add to previous studies3, 4, 5, 6, 8 in various important ways. First, in contrast to predefined subsets of ACS patients,3, 4, 6 our study examined less selected patients across the entire spectrum of ACS—from non–ST- and ST-elevation MI to unstable angina–enrolled from a variety of centers with no specific
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Cited by (42)
Improving the Prescribing Gap For Guideline Recommended Medications Post Myocardial Infarction
2019, Heart Lung and CirculationCitation Excerpt :There is compelling evidence that improved adherence to these guidelines translates to a reduction in mortality [5,6]. Despite this robust evidence base, studies continue to show a significant gap in the use of guideline recommended medications following myocardial infarction [7–12]. Reducing errors of omission, that is failure to provide evidence-based therapies, is clearly important and recently there has been a focus on implementing strategies to achieve this [13–15].
Management of Acute Coronary Syndromes
2018, Canadian Journal of DiabetesPredicting Risk in ACS: Taking the Long-Term View
2017, Journal of the American College of CardiologyA systematic review and meta-regression of temporal trends in the excess mortality associated with diabetes mellitus after myocardial infarction
2016, International Journal of CardiologyCitation Excerpt :There were 252 studies on the impact of diabetes mellitus on mortality after MI or ACS for which a detailed assessment of the full-text was performed. We finally included 110 studies [1,2,7–10,15–118]. The reasons for exclusion were: studies not reporting number and crude all-cause mortality rates of diabetic vs. nondiabetic patients (n = 23), studies not focusing on MI/ACS (n = 4), studies in which diabetic patients were matched with non-diabetic patients (n = 8), studies focusing on MI patients in cardiogenic shock (n = 5), studies not reporting the inclusion period (n = 5), studies with an inclusion period > 5 years (n = 42), studies not reporting early or 6–12 months year mortality (n = 16), and studies with overlapping data (n = 39).
Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR)
2014, American Journal of CardiologyCitation Excerpt :Our population had a considerably lower rate of smokers (34% compared with 55% in the GRACE registry); in addition, cath was performed more often in our study population with a higher rate of revascularization (in the STEMI group), which may have contributed to the lower reported mortality rates. Despite modern therapies, patients with DM presenting with STEMI and NSTEMI have a higher in-hospital mortality rate compared with patients without DM.19,20 In addition to the worse cardiac risk profile in the diabetic population, other factors such as vasculopathies that are secondary to hyperglycemia and hyperinsulinemia and disturbances in the coagulation system including platelets and the coagulation cascade may explain poorer outcomes in patients with DM.12,15,21
This research was sponsored by the Canadian Heart Research Centre and Key Pharmaceuticals, Division of Schering Canada Inc. Drs Fitchett, Lauzon, Lai, Langer, and Goodman have received research grant support and speaker/consultant honoraria from Schering Canada Inc. Dr McGuire has received research grant support and speaker/consultant honoraria from Pfizer, GlaxoSmithKline, Wyeth, Sanofi-Aventis, Guilford, and Takeda. Dr Andrew Yan is supported by the Canadian Institutes of Health Research Fellowship Award, the Canadian Heart Research Centre Fellowship, and the Detweiler Travelling Fellowship.