Author + information
- Ahmed M. Mahmoud,
- Islam Elgendy,
- Hend Mansoor,
- Mohammad Mojadidi and
- R. David Anderson
Background: The influence of an early invasive strategy on short-term survival of diabetics with non-ST-elevation acute coronary syndrome (NSTE-ACS) is unclear. We aimed to determine if an early invasive strategy led to improved in-hospital mortality in those patients.
Methods: The National Inpatient Sample years 2012-2013 was queried for diabetics with a primary diagnosis of non-ST-elevation myocardial infarction (NSTEMI) or unstable angina (UA). An early invasive strategy was defined as coronary angiogram (+/-revascularization) within 48 hours of admission. Propensity scores (matching tolerance=0.01) were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on 53 baseline demographics and hospital presentations. The incidence of in-hospital mortality was compared in both groups.
Results: In a cohort of 363,500 diabetics with NSTE-ACS, 164,740 (45.3%) were treated with an early invasive strategy. Propensity score matched 21,681 diabetics in both arms. The incidence of in-hospital mortality was lower with an early invasive strategy (2.2% vs. 3.8%; odds ratio 0.57, 95% confidence interval 0.50-0.63, P<0.01). The benefit was observed across various subgroups, except for patients with UA (Pinteraction=0.02) (Figure).
Conclusions: Although associated with lower in-hospital mortality, early invasive strategy was underutilized among diabetics with NSTE-ACS. The benefit of such strategy was obvious in patients with NSTEMI but not UA.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-336
- 2017 American College of Cardiology Foundation