Author + information
- Niels Hoedemaker1,
- Peter Damman2,
- Pier Woudstra1,
- Alexander Hirsch3,
- Jan Tijssen4 and
- Robbert de Winter5
Patients with Non-ST-segment Elevation Acute Coronary Syndrome (NSTE-ACS) and diabetes mellitus (DM) have less favorable outcomes compared to patients without DM, due to advanced multivessel coronary artery disease in patients with DM. In the ICTUS trial, an early invasive strategy did not reduce 10-year death or spontaneous MI compared to a selective invasive strategy in patients with NSTE-ACS and an elevated cardiac troponin T. In this subgroup analysis we studied 10-year outcomes in patients with DM.
In 42 Dutch hospital, 1,200 patients with NSTE-ACS and an elevated cardiac troponin were randomized to an early invasive or a selective invasive strategy. Enrollment was from July 2001 until August 2003. After 10 years, we collected follow-up of death, myocardial infarction (MI), and revascularization through the Dutch population registry, patient phone call, general practitioners and hospital records. In this subgroup analysis of patients with DM, we looked at the main composite outcome of death or spontaneous MI. Other outcomes included death, MI (spontaneous and procedure-related), and revascularization.
This analysis included 166 patients with DM, 86 patients in the early invasive group and 80 patients in the selective invasive group. Death or spontaneous MI at 10 years was 58.5% in the early invasive group and 44.4% in the selective invasive group, but was not statistically different (Hazard ratio [HR]; 1.44; 95% confidence interval [CI]: 0.93-2.22; p = 0.10). Revascularization was significantly higher in the early invasive group (83.8% vs. 68.2%, HR 2.12; 95%CI 1.47-3.07; p < 0.001). Other outcomes did not significantly differ between the two groups.
In this subgroup analysis of NSTE-ACS patients with DM, an early invasive strategy did not reduce the 10-year death or spontaneous MI compared to a selective invasive strategy, despite higher revascularization rates in the early invasive group. Risks and benefits of (repeat) revascularization should be considered when choosing an invasive strategy in NSTE-ACS patients with DM. Further research for the optimal timing of an invasive strategy in patients with DM is warranted.
CORONARY: Acute Coronary Syndromes