Characterizing Young Patients With Diabetes and Non–ST-Segment Elevation Acute Coronary Syndromes

Most information regarding the prognosis and quality of care of patients with diabetes and acute coronary syndromes (ACSs) is derived from studies that have largely focused on middle-aged and older populations (1–3). Thus, data regarding the presenting features, treatment patterns, and outcomes in smaller proportions of ACS patients with diabetes who are young (an age wherein insulin-dependent diabetes manifests, often portending poor prognosis) has been less well characterized. Accordingly, we sought to evaluate clinical features, management, and in-hospital clinical events among young patients (aged ≤45 years) with and without diabetes who presented with non–ST-segment elevation ACS (NSTE ACS) and who were included in the CRUSADE (Can Rapid Risk Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the American College of Cardiology/American Heart Association Guidelines?) Quality Improvement Initiative (4–6). The details of the CRUSADE Initiative have been previously published (4–6). In brief, patients included in the CRUSADE Quality Improvement Initiative were admitted to 498 participating U.S. hospitals with ischemic symptoms at rest within 24 h before presentation and high-risk features including ST-segment depression, transient ST-segment elevation, and/or positive cardiac markers (elevated troponin I or T and/or creatine kinase-MB more than the upper limit of normal for participating institutions). For this study, we analyzed data from 9,643 patients aged ≤45 years out of …