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Am J Med. 2019 Aug 22. pii: S0002-9343(19)30688-6. doi: 10.1016/j.amjmed.2019.07.044. [Epub ahead of print]

Fifteen years trends of cardiogenic shock and mortality in patients with diabetes and acute coronary syndromes.

Author information

1
Department of Internal Medicine, Section of Endocrinology and Diabetes, Bolzano General Hospital, Bolzano.
2
Intensive Cardiac Care Unit and De Gasperis Cardio Center, ASST Grande Ospedale Metropolitano Niguarda, Milan; Dept. of Clinical Sciences and Community Health Università degli Studi di Milano.
3
ANMCO Research Center of the Heart Care Foundation, Florence.
4
Division of Cardiology, Ospedale Sant'Antonio Abate, Tolmezzo.
5
Department of Cardiovascular Diseases, S. Giovanni-Addolorata Hospital, Rome.
6
Department of Cardiology, Ca' Foncello Hospital, Treviso.
7
Department of Cardiology, Maggiore Hospital, Bologna.
8
Division of Cardiology, San Giovanni Evangelista Hospital, Tivoli (Rome).
9
Cardiac Rehabilitation Istituti Clinici Scientifici Maugeri, IRCCS, Veruno.
10
Department of Cardiology, Multimedica IRCCS, Sesto San Giovanni.
11
Section of Endocrinology, Diabetes and Metabolism Department of Medicine, University of Verona.
12
Division of Cardiology, Ospedale Manzoni, Lecco, Italy. Electronic address: s.savonitto@asst-lecco.it.

Abstract

PURPOSE:

To examine time trends of management and mortality of acute coronary syndrome patients with associated diabetes mellitus.

METHODS:

We analyzed data from 5 nationwide registries established between 2001 and 2014, including consecutive acute coronary syndrome patients admitted to the Italian Intensive Cardiac Care Units.

RESULTS:

Out of 28,225 participants, 8521 (30.2%) had diabetes: as compared to patients without diabetes, they were older and had significantly higher rates of prior myocardial infarction and comorbidities (all p<0.0001). Prevalence of diabetes and comorbidities increased over time (p for trend <0.0001). Cardiogenic shock rates were higher in patients with diabetes, as compared to those without diabetes (7.8% vs 2.8%, p<0.0001), and decreased significantly over time only in patients without diabetes (p=0.007). Revascularization rates increased over time both in patients with and without diabetes (both p for trend <0.0001), though with persistingly lower rates in patients with diabetes. All-cause in-hospital mortality was higher in patients with diabetes (5.4 vs. 2.5%, respectively, p<0.0001) and decreased more consistently in patients without diabetes (p for trend=0.007 and<0.0001, respectively). At multivariable analysis, diabetes remains an independent predictor of both cardiogenic shock [OR 2.03, 95% C.I. 1.77-2.32, p<.0001] and mortality [OR: 1.95; 95% CI: 1.69-2.26; p<0.0001].

CONCLUSIONS:

Despite significant mortality reductions observed over 15years in acute coronary syndromes, patients with diabetes continue to show 3-fold higher rates of cardiogenic shock and lower revascularization rates as compared to patients without diabetes. These findings may explain the persistingly higher mortality of patients with diabetes and acute coronary syndromes.

KEYWORDS:

Acute Coronary Syndrome; Cardiogenic shock; Diabetes; In-hospital death; Observational Outcome Study

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