Abstract 3078: The Impact of Diabetes on Mortality in Acute Coronary Syndromes: An Analysis of 62,035 Patients from the TIMI Study Group
BACKGROUND: Prior studies have demonstrated that diabetes mellitus (DM) increases mortality after an acute coronary syndrome (ACS). We evaluated the independent prognostic value of DM on mortality using a large contemporary database spanning the full spectrum of ACS after adjusting for baseline characteristics and in-hospital management.
METHODS: TIMI Study Group clinical trial data collected after 1997 were pooled. Primary outcome was all-cause mortality at 30 days and 1 year. Baseline characteristics, aspects of ACS presentation and treatments for the index ACS event were entered into a multivariable regression model to investigate the relative impact of DM on mortality.
RESULTS: Analysis included 62,035 patients (DM=10,613) of whom 46,576 presented with STEMI. Mortality was significantly higher in diabetics than in non-diabetics at 30 days (6.4% vs. 4.4%, p<0.001) and at 1 year (10.9% vs. 6.7%, p<0.001). After adjusting for baseline characteristics, TIMI risk index, creatinine clearance and treatments received during index hospitalization, DM remained an independent predictor of 30-day mortality (HR 1.39, 95%CI 1.25–1.55, p<0.001). DM increased the risk of death among UA/NSTEMI patients (HR 2.22, 95%CI 1.87–2.63, p<0.001) and STEMI patients (HR 1.63, 95%CI 1.50–1.77, p<0.001) through 1 year with a significant interaction between DM and ACS type on mortality (p=0.003). [Figure⇓] Diabetics with UA/NSTEMI had a similar risk of death at 1 year as non-diabetics with STEMI (p=0.53).
CONCLUSION: Despite modern therapies for ACS, DM confers a significant adverse prognosis. This highlights the need for aggressive new strategies to manage this high-risk population.