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

156 Scopus citations

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
DOIs
StatePublished - Jan 1 2000

Keywords

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

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    McGuire, D. K., Emanuelsson, H., Granger, C. B., Ohman, E. M., Moliterno, D. J., White, H. D., Ardissino, D., Box, J. W., Califf, R. M., & 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. https://doi.org/10.1053/euhj.2000.2317