What is the clinical evidence from this study?

Study design: Cohort. Population: Acute Coronary Syndrome (n=2499). Intervention: Diabetes Mellitus vs. No Diabetes Mellitus. Primary outcome: All-cause mortality in patients with pre-existing cardiovascular disease (HR 1.69, 95% CI 1.39-2.11, p=<0.001).

October 21, 2008PLoS ONEOpen Access

Diabetes Mellitus and Mortality after Acute Coronary Syndrome as a First or Recurrent Cardiovascular Event

Q: What are the key findings of this study?

Diabetes mellitus was associated with a significantly higher risk of all-cause mortality following acute coronary syndrome in patients with pre-existing cardiovascular disease (HR 1.69), but not in those without prior cardiovascular disease.

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Key result

Diabetes mellitus was associated with a significantly higher risk of all-cause mortality following acute coronary syndrome in patients with pre-existing cardiovascular disease (HR 1.69), but not in those without prior cardiovascular disease.

Why the study?

Does Diabetes Mellitus increase all-cause mortality in patients presenting with Acute Coronary Syndrome?

Study Design

Type

Cohort (n=2,499)

Multicenter

Yes

Structured PICO

Does Diabetes Mellitus increase all-cause mortality in patients presenting with Acute Coronary Syndrome?

Population

2,499 patients consecutively admitted with confirmed acute coronary syndrome, followed for a median of 2 years to assess the impact of diabetes on mortality based on prior cardiovascular disease status.

Exposure

Presence of Diabetes Mellitus (DM)

Comparator

Absence of Diabetes Mellitus (No DM)

Outcome

All-cause mortality at median 2 years follow-uphard clinical

Main Result

Hazard Ratio: 1.69 (95% CI 1.39–2.11)

Absolute Event Rate: 46.7% vs 33.2%

p-value: p=<0.001

Limitations

Observational design precludes establishing causality for the findings
Lack of data on other cardiovascular risk factors such as albuminuria and obesity
Lack of detailed analysis of preventative therapy received prior to the index event
Counterintuitive rates of secondary preventative therapy provision at hospital discharge
Lack of measurements of other novel and traditional cardiovascular risk factors such as albuminuria and obesity
Lack of detailed analysis of preventative therapy received by patients prior to the index event

Discussion

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Implication

DM may confer excess post-ACS mortality only in patients with prior CVD; leaves open independent prognostic role of DM without prior disease.

Cite This Study

Cubbon et al. (2008) conducted a cohort in Acute Coronary Syndrome (n=2,499). Diabetes Mellitus vs. No Diabetes Mellitus was evaluated on All-cause mortality in patients with pre-existing cardiovascular disease (HR 1.69, 95% CI 1.39-2.11, p=<0.001). Diabetes mellitus was associated with a significantly higher risk of all-cause mortality following acute coronary syndrome in patients with pre-existing cardiovascular disease (HR 1.69), but not in those without prior cardiovascular disease.

synapsesocial.com/papers/6a9c4e93fd06842bdd5d22b4 https://doi.org/10.1371/journal.pone.0003483

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Implication

DM may confer excess post-ACS mortality only in patients with prior CVD; leaves open independent prognostic role of DM without prior disease.

Diabetes Mellitus and Mortality after Acute Coronary Syndrome as a First or Recurrent Cardiovascular Event

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Diabetes Mellitus and Mortality after Acute Coronary Syndrome as a First or Recurrent Cardiovascular Event

Study Design

Structured PICO

Main Result

Limitations

Discussion

Implication

Cite This Study

Also Consider

Also Consider