Diabetes is a major risk factor for cardiovascular disease and is associated with an increased risk of mortality in the setting of acute coronary syndromes. Like patients without diabetes, ST elevation and non-ST elevation myocardial infarction patients mandate immediate and within 24 h coronary angiography, respectively. Even in the absence of troponin elevation, all patients with diabetes with suspected acute coronary syndromes should undergo coronary angiography within 72 h due to their increased risk (which is not the case for individuals without diabetes). Antiplatelet treatment should be handled as in patients without diabetes, and the more potent P2Y12 inhibitors prasugrel and ticagrelor should be preferred over clopidogrel. Overall, trials investigating the impact of intensive glucose-lowering therapies in the acute phase of acute coronary syndromes did not show a positive impact on clinical outcomes. In the long term, efforts in secondary prevention to reach recommended global preventive targets are especially important in this patient population to improve survival and reduce the recurrence of ischaemic events.
5258Trends and outcomes of use of coronary angiography in management of non-ST-Elevation acute coronary syndromes (NSTEACS), a population based cohort study