Can diabetic status help in determining adverse events of acute coronary syndromes?

This study aimed to determine the timing of mortality and other non-fatal adverse events according to diabetic status and type of acute coronary syndrome (ACS).

It was found that the type of ACS but not the diabetic status determines the timing of fatal and non-fatal adverse events.

Patients with diabetes mellitus do not produce, or do not produce enough,  insulin. Insulin is a hormone produced by the body that breaks down the sugar (glucose) taken in from food. High levels of blood glucose can lead to many different complications. Heart attacks are a common complication of diabetes.

Acute coronary syndromes (ACS) occur when the blood supply for the heart is blocked. Non-ST segment elevation myocardial infarction (NSTE) and ST segment elevation myocardial infarction (STEMI) are two types of ACS. NSTE-ACS causes partial or temporary blockages of the blood supply while STEMI causes complete blockage of the blood supply. Both blockages result in heart attacks.

Adverse events (AEs) that can occur after NSTE-ACS and STEMI (such as increased mortality risk) depends on the type of ACS. The risk is higher in the 30 days following STEMI. The risk is higher in the longer-term following NSTE.  However it is not known if diabetes affects the time of occurrence of AEs in patients with ACS undergoing percutaneous coronary intervention (PCI, a non-surgical treatment for ACS).

This study examined the records and data from 9492 patients with ACS undergoing PCI who took part in clinical studies. 20.3% of patients had diabetes mellitus. Of these patients, 30.7% had STEMI and 69.3% had NSTE-ACS. 79.7% patients of patients did not have diabetes. Of these patients, 44.1% had STEMI and 55.9% had NSTE-ACS. Early, late and overall events were monitored.

In diabetes patients, the rate of mortality at 1 year was 13.4% in patients with STEMI and 10.3% in patients with NSTE-ACS. In non-diabetes patients, the rate of mortality at 1 year was 6.4% in patients with STEMI and 4.4% in patients with NSTE-ACS.

In diabetic patients and non-diabetic with STEMI the risk of mortality was much greater in the early period when compared to the late period.

Diabetic patients with STEMI were over two times more likely to have early stent thrombosis (blockage due to a blood clot) when compared to diabetic NSTE-ACS patients.

This study concluded that STEMI and NSTE-ACS diabetes patients had a higher risk of mortality when compared to non-diabetic patients. However, the timing of fatal and non-fatal events depends on type of ACS and was independent of diabetic status.

The authors suggested that patients with diabetes should consider treatment with antiplatelet therapy to decrease the risk of blood clots.

Talk to your physician about your risk of adverse events, and ways to decrease the risks.