Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes

Findings from the GUSTO-IIb study

Darren K McGuire, H. Emanuelsson, C. B. Granger, E. Magnus Ohman, D. J. Moliterno, H. D. White, D. Ardissino, J. W. Box, R. M. Califf, E. J. Topol

Research output: Contribution to journalArticle

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Abstract

Aims: We examined the characteristics, outcomes, and effects of hirudin vs heparin treatment of diabetic patients across the spectrum of acute coronary syndromes. Methods and Results: We studied the 12 142 patients enrolled in the randomized GUSTO-IIb study. Diabetic patients (n=2175) were older, more often female, more often had prior cardiovascular disease, hypertension, and hyperlipidaemia, and less often were current smokers. Diabetic patients had a higher overall incidence of death or (re)infarction at 30 days (13.1% vs 8.5%, P=0.0001), whether they presented with ST-segment elevation (13.9% vs 9.9%, P=0.0017) or not (12.8% vs 7.8%, P=0.0001), and at 6 months (18.8% vs 11.4%, P=0.0001). Among diabetic patients, hirudin was associated with a tendency toward a lower risk of death or (re)infarction at 30 days (12.2% vs 13.9% with heparin) and 6 months (17.8% vs 20.2%). Diabetic patients had more major bleeding, stroke, heart failure, shock, atrioventricular block, and atrial arrhythmias, but no increased risk for ocular bleeding. Conclusions: Diabetic patients with acute coronary syndromes had worse 30-day and 6-month outcomes, particularly those without ST-segment elevation. The statistically non-significant trend toward improved outcomes with hirudin was similar among patients with and without diabetes, with a greater point estimate for the absolute difference in patients with diabetes. (C) 2000 The European Society of Cardiology.

Original languageEnglish (US)
Pages (from-to)1750-1758
Number of pages9
JournalEuropean Heart Journal
Volume21
Issue number21
StatePublished - 2000

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Acute Coronary Syndrome
Diabetes Mellitus
Hirudins
Infarction
Heparin
Hemorrhage
Atrioventricular Block
Hyperlipidemias
Cardiac Arrhythmias
Shock
Cardiovascular Diseases
Heart Failure
Stroke
Hypertension
Incidence

Keywords

  • Diabetes mellitus
  • Heparin
  • Hirudin
  • Myocardial infarction
  • Unstable angina

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

McGuire, D. K., Emanuelsson, H., Granger, C. B., Ohman, E. M., Moliterno, D. J., White, H. D., ... Topol, E. J. (2000). Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes: Findings from the GUSTO-IIb study. European Heart Journal, 21(21), 1750-1758.

Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes : Findings from the GUSTO-IIb study. / McGuire, Darren K; Emanuelsson, H.; Granger, C. B.; Ohman, E. Magnus; Moliterno, D. J.; White, H. D.; Ardissino, D.; Box, J. W.; Califf, R. M.; Topol, E. J.

In: European Heart Journal, Vol. 21, No. 21, 2000, p. 1750-1758.

Research output: Contribution to journalArticle

McGuire, DK, Emanuelsson, H, Granger, CB, Ohman, EM, Moliterno, DJ, White, HD, Ardissino, D, Box, JW, Califf, RM & Topol, EJ 2000, 'Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes: Findings from the GUSTO-IIb study', European Heart Journal, vol. 21, no. 21, pp. 1750-1758.
McGuire, Darren K ; Emanuelsson, H. ; Granger, C. B. ; Ohman, E. Magnus ; Moliterno, D. J. ; White, H. D. ; Ardissino, D. ; Box, J. W. ; Califf, R. M. ; Topol, E. J. / Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes : Findings from the GUSTO-IIb study. In: European Heart Journal. 2000 ; Vol. 21, No. 21. pp. 1750-1758.
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abstract = "Aims: We examined the characteristics, outcomes, and effects of hirudin vs heparin treatment of diabetic patients across the spectrum of acute coronary syndromes. Methods and Results: We studied the 12 142 patients enrolled in the randomized GUSTO-IIb study. Diabetic patients (n=2175) were older, more often female, more often had prior cardiovascular disease, hypertension, and hyperlipidaemia, and less often were current smokers. Diabetic patients had a higher overall incidence of death or (re)infarction at 30 days (13.1{\%} vs 8.5{\%}, P=0.0001), whether they presented with ST-segment elevation (13.9{\%} vs 9.9{\%}, P=0.0017) or not (12.8{\%} vs 7.8{\%}, P=0.0001), and at 6 months (18.8{\%} vs 11.4{\%}, P=0.0001). Among diabetic patients, hirudin was associated with a tendency toward a lower risk of death or (re)infarction at 30 days (12.2{\%} vs 13.9{\%} with heparin) and 6 months (17.8{\%} vs 20.2{\%}). Diabetic patients had more major bleeding, stroke, heart failure, shock, atrioventricular block, and atrial arrhythmias, but no increased risk for ocular bleeding. Conclusions: Diabetic patients with acute coronary syndromes had worse 30-day and 6-month outcomes, particularly those without ST-segment elevation. The statistically non-significant trend toward improved outcomes with hirudin was similar among patients with and without diabetes, with a greater point estimate for the absolute difference in patients with diabetes. (C) 2000 The European Society of Cardiology.",
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AU - Ohman, E. Magnus

AU - Moliterno, D. J.

AU - White, H. D.

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AU - Califf, R. M.

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N2 - Aims: We examined the characteristics, outcomes, and effects of hirudin vs heparin treatment of diabetic patients across the spectrum of acute coronary syndromes. Methods and Results: We studied the 12 142 patients enrolled in the randomized GUSTO-IIb study. Diabetic patients (n=2175) were older, more often female, more often had prior cardiovascular disease, hypertension, and hyperlipidaemia, and less often were current smokers. Diabetic patients had a higher overall incidence of death or (re)infarction at 30 days (13.1% vs 8.5%, P=0.0001), whether they presented with ST-segment elevation (13.9% vs 9.9%, P=0.0017) or not (12.8% vs 7.8%, P=0.0001), and at 6 months (18.8% vs 11.4%, P=0.0001). Among diabetic patients, hirudin was associated with a tendency toward a lower risk of death or (re)infarction at 30 days (12.2% vs 13.9% with heparin) and 6 months (17.8% vs 20.2%). Diabetic patients had more major bleeding, stroke, heart failure, shock, atrioventricular block, and atrial arrhythmias, but no increased risk for ocular bleeding. Conclusions: Diabetic patients with acute coronary syndromes had worse 30-day and 6-month outcomes, particularly those without ST-segment elevation. The statistically non-significant trend toward improved outcomes with hirudin was similar among patients with and without diabetes, with a greater point estimate for the absolute difference in patients with diabetes. (C) 2000 The European Society of Cardiology.

AB - Aims: We examined the characteristics, outcomes, and effects of hirudin vs heparin treatment of diabetic patients across the spectrum of acute coronary syndromes. Methods and Results: We studied the 12 142 patients enrolled in the randomized GUSTO-IIb study. Diabetic patients (n=2175) were older, more often female, more often had prior cardiovascular disease, hypertension, and hyperlipidaemia, and less often were current smokers. Diabetic patients had a higher overall incidence of death or (re)infarction at 30 days (13.1% vs 8.5%, P=0.0001), whether they presented with ST-segment elevation (13.9% vs 9.9%, P=0.0017) or not (12.8% vs 7.8%, P=0.0001), and at 6 months (18.8% vs 11.4%, P=0.0001). Among diabetic patients, hirudin was associated with a tendency toward a lower risk of death or (re)infarction at 30 days (12.2% vs 13.9% with heparin) and 6 months (17.8% vs 20.2%). Diabetic patients had more major bleeding, stroke, heart failure, shock, atrioventricular block, and atrial arrhythmias, but no increased risk for ocular bleeding. Conclusions: Diabetic patients with acute coronary syndromes had worse 30-day and 6-month outcomes, particularly those without ST-segment elevation. The statistically non-significant trend toward improved outcomes with hirudin was similar among patients with and without diabetes, with a greater point estimate for the absolute difference in patients with diabetes. (C) 2000 The European Society of Cardiology.

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