Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-St-Elevation Acute Coronary Syndromes: A Contemporary National Insight

Ahmed N. Mahmoud, Islam Y. Elgendy, Hend Mansoor, Xuerong Wen, Mohammad K. Mojadidi, Anthony A. Bavry, R. David Anderson

Research output: Contribution to journalArticle

7 Scopus citations

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 propensitymatched 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.

Original languageEnglish (US)
Article numbere005369
JournalJournal of the American Heart Association
Volume6
Issue number3
DOIs
StatePublished - Mar 2017
Externally publishedYes

Keywords

  • Acute coronary syndrome
  • Early invasive strategy
  • Mortality
  • Propensity score analysis

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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