P3686Statin therapy improves glycemic control in diabetic patients admitted with acute coronary syndromes

OBJECTIVES: It is well recognized that cardiac autonomic neuropathy associated with diabetes mellitus (DM) can cause silent myocardial ischemia, however there is limited research examining how the cardiac symptoms reported by patients with DM presenting with acute coronary syndromes (ACS) can affect the immediate and long term outcomes. The aim of the current study was to examine the prognostic impact of lack of chest pain symptoms in DM patients presenting with ACS and enrolled in a multicenter multinational ACS registry from the Middle East. METHODS: For a period of 9 months in 2008 to 2009, 7,930 consecutive patients with ACS were enrolled from 65 hospitals in 6 Middle East countries. A cohort of 3135 patients with DM were selected of whom 2686 (85.7%) presented with chest pain while 449 patients (14.3%) had no chest pain. Clinical features and outcomes were examined and compared among the two groups. RESULTS: Diabetic patients without chest pain were 5 years older and had significantly higher rates of hypertension (76.1% vs. 63.2%), prior myocardial infarction (35.9% vs. 24.3%), chronic kidney disease (CKD) (17.1% vs. 5.9%) and had significantly higher GRACE risk scores (55.3% vs. 21.4%) at presentation compared to patients with chest pain [All P <0.001]. Covariates independently associated with lack of chest pain in DM patients were; higher Killip class on presentation (OR, 6.2 [95%CI, 4.80-7.88]), female gender (OR, 1.50 [95%CI, 1.14-1.96]), CKD (OR, 1.8 [95%CI, 1.27-2.61]), tachycardia (OR, 2.50 [95%CI, 1.94-3.19]) and advanced age (OR, 1.03 [95%CI, 1.02-1.04]), [All P =0.001]. DM patients without chest pain had a significantly higher in-hospital and 1-year mortality rates (11.4% vs. 3.8%, P =0.001, and 25.7% vs. 12.2%, P =0.001, respectively). Lack of chest pain was an independent predictor of in-hospital and one year mortality (OR, 3.05 [95%CI, 2.05-4.54], P =0.001, and OR, 2.0 [95%CI, 1.52-2.75], P =0.001, respectively). CONCLUSIONS: DM patients with ACS presenting without chest pain are at an increased risk of immediate and long term mortality. Understanding the factors associated with atypical presentations of ACS in patients with DM may help in the earlier detection and more appropriate management of these high risk patients.

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Abstract 3220: Bivalirudin Monotherapy Provides Similar One-Year Survival Compared to Heparin plus GP IIb/IIIa Inhibitors in Diabetic Patients with Acute Coronary Syndromes: Results from the Randomized ACUITY Trial

Circulation ◽

10.1161/circ.116.suppl_16.ii_724-b ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Frederick Feit ◽

Stuart V Manoukian ◽

George D Dangas ◽

A. M Lincoff ◽

E. M Ohman ◽

...

Keyword(s):

Treatment Group ◽

High Risk ◽

Major Bleeding ◽

Acute Coronary Syndromes ◽

Diabetic Patients ◽

Significant Difference ◽

Coronary Syndromes ◽

One Year ◽

The Impact ◽

Ischemic Events

Background: Among diabetic patients with acute coronary syndromes (ACS) in the ACUITY trial, bivalirudin (Biv) monotherapy (Mono) provided similar survival and protection from ischemic events with significantly less major bleeding compared to heparin (unfractionated or enoxaparin) plus GP IIb/IIIa inhibitors (Hep+GPI) at 30 days. Whether this protection from ischemic events persists to one year is unknown. Methods: In the ACUITY trial, patients with moderate and high risk (ACS) were randomized to Hep+GPI, Biv+gPI, or Biv Mono. We evaluated the impact of treatment group on composite ischemia (death, MI, or unplanned revascularization) and mortality at one year in diabetic patients using Kaplan Meier survival analysis and log rank tests. Results: Of patients enrolled in the ACUITY trial, 3852 were diabetic (28.1%) and 9857 (71.9%) were non-diabetic. Compared with non-diabetics, diabetics had higher rates of mortality at one year (6.1% vs 3.4%, p<0.001). There was no significant difference in the rate of composite ischemia at one year for diabetic patients who received Biv Mono vs Hep+GPI (19.7% vs 18.9%, p=0.39) or Biv+GPI vs Hep+GPI (20.9% vs 18.9%, p=0.16). Mortality rates for diabetic patients by treatment group are shown below. Conclusions: In the ACUITY Trial, diabetic patients had lower survival rates at one year than non-diabetics. Among diabetic patients, treatment with Biv Mono resulted in similar rates of composite ischemia and survival at one year compared to those treated with Hep+GPI. Combined with the early reduction in major bleeding, these findings indicate that Biv Mono is a suitable alternative to Hep + GPI for diabetic patients with moderate and high risk ACS.

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