Background
Research design and methods
Study design and population
Definition of diabetes
Definition of in-hospital outcomes
Definition of other variables
Statistical analysis
Results
Prevalence of diabetes in ACS patients
Total ACS (N = 63,450) | STEMI (N = 39,793) | NSTE-ACS (N = 23,657) | |
---|---|---|---|
Total, n (% [95% CI]) | 23,880 (37.6 [37.3–38.0]) | 14,650 (36.8 [36.3–37.3]) | 9230 (39.0 [38.4–39.6]) |
Sex, n (% [95% CI]) | |||
Male | 16,721 (35.2 [34.8–35.6]) | 10,746 (34.5 [34.0–35.0]) | 5975 (36.5 [35.7–37.2]) |
Female | 7159 (45.0 [44.2–45.7]) | 3904 (45.1 [44.1–46.2]) | 3255 (44.7 [43.6–45.9]) |
Age, n (% [95% CI]) (years) | |||
< 45 | 1281 (26.9 [25.6–28.1]) | 1003 (27.5 [26.1–29.0]) | 278 (24.7 [22.2–27.2]) |
45–64 | 10,726 (36.2 [35.6–36.7]) | 7041 (36.1 [35.4–36.8]) | 3685 (36.2 [35.3–37.2]) |
≥ 65 | 11,873 (40.9 [40.4-41.5]) | 6606 (39.7 [38.9-40.4]) | 5267 (42.6 [41.8–43.5]) |
CHD history, n (% [95% CI]) | |||
Yes | 3197 (45.9 [44.7–47.1]) | 1186 (44.3 [42.4–46.2]) | 1186 (44.3 [42.4–46.2]) |
No | 20,683 (36.6 [36.2–37.0]) | 13,464 (36.3 [35.8–36.8]) | 7219 (37.3 [36.6–38.0]) |
Characteristics of ACS patients with diabetes
All ACS | STEMI | NSTE-ACS | |||||||
---|---|---|---|---|---|---|---|---|---|
Diabetes/possible diabetes (N = 23,880) | No diabetes (N = 39,570) | p value | Diabetes/possible diabetes (N = 14,650) | No diabetes (N = 25,143) | p value | Diabetes/possible diabetes (N = 9230) | No diabetes (N = 14,427) | p value | |
Age, mean (SD), years | 64.2 (11.9) | 62.1 (12.7) | < 0.001 | 62.9 (12.0) | 61.0 (12.9) | < 0.001 | 66.3 (11.3) | 64.1 (12.2) | < 0.001 |
Women, n (%) | 7159 (30.0) | 8764 (22.2) | < 0.001 | 3904 (26.7) | 4744 (18.9) | < 0.001 | 3255 (35.3) | 4020 (27.9) | < 0.001 |
Vital signs | |||||||||
SBP levels, mean (SD) | 131.7 (24.3) | 129.1 (22.9) | < 0.001 | 128.4 (24.2) | 126.3 (22.9) | < 0.001 | 136.9 (23.5) | 133.9 (22.1) | < 0.001 |
DBP levels, mean (SD) | 77.9 (14.5) | 78.0 (14.3) | 0.543 | 77.8 (15.0) | 77.5 (14.6) | 0.629 | 78.4 (13.5) | 78.8 (13.6) | 0.040 |
Heart rate, mean (SD) | 79.6 (17.2) | 76.1 (15.5) | < 0.001 | 80.0 (17.5) | 76.8 (15.8) | < 0.001 | 79.1 (16.6) | 74.8 (14.8) | < 0.001 |
Risk factors | |||||||||
Hypertension, n (%) | 17,180 (71.9) | 24,176 (61.1) | < 0.001 | 9961 (68.0) | 14,350 (57.1) | < 0.001 | 7219 (78.2) | 9826 (68.1) | < 0.001 |
Elevated LDL-Ca, n (%) | 18,024 (83.7) | 30,517 (85.1) | 0.010 | 11,375 (86.5) | 19,760 (86.9) | 0.257 | 6649 (79.3) | 10,757 (82.0) | < 0.001 |
Low HDL-Cb, n (%) | 10,634 (49.1) | 15,238 (42.4) | < 0.001 | 6293 (47.6) | 9768 (42.8) | < 0.001 | 4341 (51.5) | 5470 (41.6) | < 0.001 |
Elevated TGc, n (%) | 5194 (23.9) | 5911 (16.4) | < 0.001 | 3094 (23.3) | 3659 (16.0) | < 0.001 | 2100 (24.9) | 2252 (17.1) | < 0.001 |
Current smoker, n (%) | |||||||||
Men | 8499 (50.8) | 17,421 (56.6) | < 0.001 | 5848 (54.4) | 12,081 (59.2) | < 0.001 | 2651 (44.4) | 5340 (51.3) | < 0.001 |
Women | 572 (8.0) | 851 (9.7) | < 0.001 | 371 (9.5) | 547 (11.5) | 0.002 | 201 (6.2) | 304 (7.6) | 0.021 |
History of diseases | |||||||||
CHD, n (%) | 3197 (13.4) | 3766 (9.5) | < 0.001 | 1186 (8.1) | 1491 (5.9) | < 0.001 | 2011 (21.8) | 2275 (15.8) | < 0.001 |
Cerebrovascular disease, n (%) | 2911 (12.2) | 3200 (8.1) | < 0.001 | 1587 (10.8) | 1850 (7.4) | < 0.001 | 1324 (14.3) | 1350 (9.4) | < 0.001 |
Heart failure, n (%) | 706 (3.0) | 553 (1.4) | < 0.001 | 199 (1.4) | 178 (0.7) | < 0.001 | 507 (5.5) | 375 (2.6) | < 0.001 |
Atrial fibrillation, n (%) | 674 (2.8) | 855 (2.2) | < 0.001 | 253 (1.7) | 328 (1.3) | 0.001 | 421 (4.6) | 527 (3.7) | 0.001 |
PAD, n (%) | 293 (1.2) | 325 (0.8) | < 0.001 | 102 (0.7) | 145 (0.6) | 0.143 | 191 (2.1) | 180 (1.3) | <0.001 |
Renal failure, n (%) | 645 (2.7) | 423 (1.1) | < 0.001 | 237 (1.6) | 188 (0.8) | < 0.001 | 408 (4.4) | 235 (1.6) | < 0.001 |
Severe clinical conditions | |||||||||
Heart failured, n (%) | 2805 (11.9) | 2813 (7.2) | < 0.001 | 1683 (11.6) | 1816 (7.3) | < 0.001 | 1122 (12.3) | 997 (7.0) | < 0.001 |
Cardiac shocke, n (%) | 874 (3.7) | 1049 (2.7) | < 0.001 | 728 (5.0) | 892 (3.6) | < 0.001 | 146 (1.6) | 157 (1.1) | 0.001 |
Cardiac arrestf, n (%) | 522 (2.2) | 693 (1.8) | < 0.001 | 427 (2.9) | 605 (2.4) | 0.005 | 95 (1.0) | 88 (0.6) | < 0.001 |
Killip classg, n (%) | < 0.001 | < 0.001 | < 0.001 | ||||||
II–III | 6700 (28.1) | 9406 (23.8) | 3924 (26.9) | 5870 (23.4) | 2776 (30.2) | 3536 (24.6) | |||
IV | 1569 (6.6) | 1725 (4.4) | 1147 (7.9) | 1325 (5.3) | 422 (4.6) | 400 (2.8) | |||
Fivefold elevated myocardial injury markerh | 16,800 (72.7) | 26,759 (70.5) | < 0.001 | 11,779 (82.6) | 19,638 (81.0) | < 0.001 | 5021 (56.8) | 7121 (51.9) | < 0.001 |
GRACE score ≥ 140i, n (%) | 8632 (39.2) | 11,196 (31.2) | < 0.001 | 9074 (65.7) | 16,819 (72) | < 0.001 | 3887 (47.3) | 4644 (37.0) | < 0.001 |
Type of ACS, n (%) | < 0.001 | ||||||||
STEMI | 14,650 (61.4) | 25,143 (63.5) | – | – | – | – | – | – | |
NSTE-ACS | 9230 (38.7) | 14,427 (36.5) | – | – | – | – | – | – | |
Patients with referral, n (%) | 10,148 (42.5) | 18,396 (46.5) | < 0.001 | 7198 (49.2) | 13,347 (53.1) | < 0.001 | 2950 (32.0) | 5049 (35.0) | < 0.001 |
In-hospital management of ACS patients with diabetes
STEMI | NSTE-ACS | |||||
---|---|---|---|---|---|---|
Diabetes/possible diabetes (N = 14,650) | No diabetes (N = 25,143) | p value | Diabetes/possible diabetes (N = 9230) | No diabetes (N = 14,427) | p value | |
DAPT, % (n/N) | 95.4 (13,911/14,577) | 95.5 (23,915/25,037) | 0.686 | 89.4 (8130/9098) | 90.0 (12,827/14,250) | 0.108 |
Aspirin, % (n/N) | 96.3 (14,032/14,579) | 96.5 (24,163/25,038) | 0.184 | 93.1 (8469/9100) | 93.6 (13,343/14,253) | 0.099 |
P2Y12 inhibitors, % (n/N) | 96.9 (14,194/14,643) | 96.7 (24,295/25,135) | 0.134 | 92.7 (8534/9211) | 92.9 (13,394/14,411) | 0.395 |
GPIIb/IIIa, % (n/N) | 39.8 (5816/14,625) | 38.4 (9651/25,112) | 0.008 | 17.5 (1612/9196) | 17.3 (2494/14,406) | 0.668 |
Anticoagulant, % (n/N) | 79.4 (11,632/14,643) | 79.2 (19,912/25,135) | 0.606 | 68.1 (6273/9211) | 67.1 (9668/14,411) | 0.104 |
UFH | 5.3 (768/14,623) | 4.5 (1121/25,097) | < 0.001 | 2.0 (185/9171) | 1.9 (271/14,379) | 0.472 |
LMWH | 73.0 (10,676/14,623) | 73.7 (18,490/25,097) | 0.147 | 62.8 (5760/9171) | 62.4 (8969/14,379) | 0.505 |
Fondaparinux sodium | 1.3 (186/14,623) | 1.0 (262/25,097) | 0.038 | 2.2 (201/9171) | 1.6 (232/14,379) | 0.001 |
Other anticoagulants | 1.9 (280/14,623) | 2.0 (512/25,097) | 0.389 | 2.0 (185/9171) | 2.0 (280/14,379) | 0.707 |
Statins, % (n/N) | 94.1(37,382/39,735) | 94.0 (13,748/14,628) | 0.544 | 92.9 (8562/9212) | 93.4 (13,459/14,408) | 0.161 |
Beta-blockers, % (n/N) | 64.3 (2917/4536) | 62.5 (4998/7997) | 0.044 | 67.6 (2046/3028) | 66.4 (3431/5164) | 0.295 |
ACEI/ARB, % (n/N) | 49.8 (6687/13,427) | 48.4 (11,151/23,030) | 0.011 | 54.0 (4643/8606) | 48.8 (6535/13,396) | < 0.001 |
PCI, % (n/N) | 77.1 (11,289/14,650) | 77.5 (19,484/25,143) | < 0.001 | 58.2 (5367/9230) | 61.1 (8810/14,427) | 0.006 |
Time of PCIa, % (n/N) (h) | < 0.001 | 0.006 | ||||
< 2 | 55.2 (8574/15,526) | 57.4 (5220/9100) | 10.0 (734/7341) | 8.9 (388/4383) | ||
2–11.9 | 10.2 (1577/15,526) | 11.5 (1046/9100) | 10.0 (731/7341) | 10.8 (474/4383) | ||
12–23.9 | 3.2 (493/15,526) | 3.4 (313/9100) | 7.8 (572/7341) | 7.2 (314/4383) | ||
24–71.9 | 9.8 (1524/15,526) | 8.9 (809/9100) | 31.2 (2293/7341) | 29.5 (1294/4383) | ||
≥ 72 | 21.6 (3358/15,526) | 18.8 (1712/9100) | 41.0 (3011/7341) | 43.7 (1913/4383) | ||
Type of stentsb, % (n/N) | 0.010 | 0.088 | ||||
Drug eluting stent | 98.1 (9827/10,017) | 98.1 (16,825/17,145) | 96.9 (4317/4456) | 96.7 (6997/7235) | ||
Bare metal stent | 1.0 (101/10,017) | 1.2 (213/17,145) | 1.8 (82/4456) | 1.6 (113/7235) | ||
Other | 0.9 (89/10,017) | 0.6 (107/17,145) | 1.3 (57/4456) | 1.7 (125/7235) | ||
CABG, % (n/N) | 0.5 (46/10,121) | 0.5 (94/17,328) | 0.324 | 0.7 (33/4670) | 0.7 (51/7583) | 0.824 |
Length of stay, median (IQR), day | 10.0 (7.0–13.0) | 10.0 (7.0–13.0) | < 0.001 | 10.0 (7.0–13.0) | 9.0 (7.0–12.0) | < 0.001 |
In-hospital outcomes of ACS patients with diabetes
All ACS | STEMI | NSTE-ACS | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
Unadjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | Unadjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | Unadjusted OR (95% CI) | p value | Adjusted OR (95% CI) | p value | |
The whole study population | ||||||||||||
All-cause deatha | 2.49 (2.22–2.80) | < 0.001 | 2.04 (1.78–2.33) | < 0.001 | 2.45 (2.14–2.80) | < 0.001 | 2.07 (1.76–2.43) | < 0.001 | 2.76 (2.19–3.47) | < 0.001 | 1.93 (1.48–2.51) | < 0.001 |
MACCEb | 1.98 (1.80–2.18) | < 0.001 | 1.54 (1.39–1.72) | < 0.001 | 2.03 (1.81–2.27) | < 0.001 | 1.66 (1.46–1.89) | < 0.001 | 1.92 (1.60–2.29) | < 0.001 | 1.30 (1.06–1.58) | 0.010 |
Propensity score-matched population | ||||||||||||
All-cause death | 2.08 (1.74–2.47) | < 0.0001 | 2.21 (1.83–2.66) | < 0.001 | 2.18 (1.77–2.69) | < 0.001 | 2.34 (1.87–2.92) | < 0.001 | 1.85 (1.34–2.54) | < 0.001 | 1.96 (1.39–2.77) | < 0.001 |
MACCE | 1.55 (1.36–1.77) | < 0.001 | 1.58 (1.38–1.82) | < 0.001 | 1.65 (1.4–1.94) | < 0.001 | 1.73 (1.46–2.05) | < 0.001 | 1.35 (1.06–1.71) | 0.015 | 1.31 (1.02–1.69) | 0.033 |