While overall mortality rates have declined with early treatment among patients with acute coronary syndromes (ACS), those with comorbid diabetes have significantly higher rates of cardiogenic shock and lower rates of revascularization, according to study results published in The American Journal of Medicine.

The study included patients with ACS admitted to the intensive cardiac care units network in Italy (n=28,225). Data were collected from 5 nationwide registries established between 2001 and 2014.

In total, 30.2% of the included patients had diabetes (n=8521). Compared with patients who did not have diabetes, patients with ACS and diabetes tended to be older and had significantly higher comorbidity burden as well as rates of prior myocardial infarction, stroke, and revascularization procedures (all P <.0001). Over time, the prevalence of diabetes and comorbidities increased (all P <.0001).

Patients with diabetes had higher rates of cardiogenic shock compared with those without diabetes (7.8% vs 2.8%; P <.0001). The rate of cardiogenic shock decreased over time for patients without diabetes (P =.007), but this trend was not seen for those with diabetes.

Over the 15-year study period, the researchers found that revascularization rates increased for patients with and without diabetes (both P <.0001), but rates were lower for those with diabetes. Patients with diabetes more often received only medical therapy compared with those without diabetes (42.3% vs 36.1%; P <.0001).

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Patients with diabetes had higher all-cause in-hospital mortality compared with those without diabetes (5.4% vs 2.5%; P <.0001). In addition, mortality rates decreased more consistently for patients without diabetes and remained ≥2-fold higher in patients with diabetes across all study years.

After performing multivariable analysis, the researchers found that diabetes was an independent risk factor for both cardiogenic shock (odds ratio, 2.03; 95% CI, 1.77-2.32; P <.0001) and mortality (odds ratio, 1.95; 95% CI, 1.69-2.26; P <.0001).

“According to the present data, acute care of [ACSs] has provided consistent benefit both in patients without and with diabetes. More effort should be devoted to preventing the first [ACS] event through aggressive risk factor control, as well as ischemic recurrencies and left ventricle deterioration by a more extensive integration of recent pharmacological advances in antidiabetic therapy,” the researchers wrote.

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Reference

Dauriz M, Morici N, Gonzini L, et al. Fifteen years trends of cardiogenic shock and mortality in patients with diabetes and acute coronary syndromes [published online August 22, 2019]. Am J Med. doi:10.1016/j.amjmed.2019.07.044