Clinical investigation: acute ischemic heart diseaseAssociation of diabetes mellitus and glycemic control strategies with clinical outcomes after acute coronary syndromes☆
Section snippets
Study population
The SYMPHONY and 2nd SYMPHONY studies evaluated the effect of sibrafiban, an oral glycoprotein IIb/IIIa antagonist, in patients after ACS. Together, they enrolled 15,904 patients between 1997 and 1999 at 931 clinical centers in 37 countries. The primary results from both trials have been published.6, 7 Patients were enrolled ≤7 days after ACS. SYMPHONY randomly assigned 9233 patients to 90 days of treatment with aspirin or 1 of 2 dosing strategies of sibrafiban. The 2nd SYMPHONY randomly
Results
Of the 15,800 patients evaluated, 3101 (19.6%) had diabetes. Diabetic patients were older, heavier, more often female and hypertensive, less often smokers, and had a higher prevalence of prior MI, revascularization, and congestive heart failure (Table I). Diabetic patients were also more likely to have unstable angina and less likely to have ST-segment elevation MI as their qualifying ACS.
Diabetes was associated with a higher unadjusted 90-day risk of death/MI/SRI (11.4% vs 9.0%, P < .001) (
Discussion
Our findings demonstrate the substantial cardiovascular risk associated with diabetes after ACS and are consistent with prior studies.2, 3, 4 In addition, since concomitant medication use was collected throughout the period of observation in the SYMPHONY trials, we were able to explore the association of various glycemic control strategies with outcomes. A novel finding from these analyses is that a glycemic control strategy using insulin-providing versus insulin-sensitizing therapy was
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The SYMPHONY and 2nd SYMPHONY trials were supported by a grant from F. Hoffmann-La Roche, Ltd, Basel, Switzerland.
Guest Editor for this manuscript was W. Douglas Weaver, MD, Henry Ford Heart and Vascular Institute, Detroit, Mich.