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 Mar 18;6(3):e005369. doi: 10.1161/JAHA.116.005369.

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.

Keywords: acute coronary syndrome; early invasive strategy; mortality; propensity score analysis.

Publication types

  • Multicenter Study

MeSH terms

  • Acute Coronary Syndrome / diagnosis
  • Acute Coronary Syndrome / mortality
  • Acute Coronary Syndrome / surgery*
  • Aged
  • Cause of Death / trends
  • Coronary Angiography
  • Diabetes Mellitus / mortality*
  • Electrocardiography*
  • Female
  • Follow-Up Studies
  • Hospital Mortality / trends
  • Hospitalization / trends
  • Humans
  • Male
  • Myocardial Revascularization / standards*
  • Odds Ratio
  • Practice Guidelines as Topic*
  • Propensity Score
  • Reproducibility of Results
  • Survival Rate / trends
  • Time Factors
  • United States / epidemiology