What is the clinical evidence from this study?

Study design: Cohort. Population: Acute coronary syndrome and diabetes mellitus (n=11870). Intervention: Pre-existing diabetes mellitus vs. Newly diagnosed diabetes mellitus. Primary outcome: All-cause mortality at 3 years (p=<0.001).

What question did this study set out to answer?

To evaluate clinical outcomes and optimal HbA1c target levels among acute coronary syndrome patients with newly diagnosed versus pre-existing diabetes mellitus.

February 25, 2025Current Vascular PharmacologyOpen Access

Comparison of Clinical Outcomes between Newly Diagnosed and Pre-Existing Diabetes Mellitus Patients after Acute Coronary Syndrome

Q: What are the key findings of this study?

Pre-existing diabetes mellitus was associated with a significantly higher rate of all-cause mortality at three years compared to newly diagnosed diabetes in patients with acute coronary syndrome (56.62% vs. 30.69%).

Q: What question did this study set out to answer?

To evaluate clinical outcomes and optimal HbA1c target levels among acute coronary syndrome patients with newly diagnosed versus pre-existing diabetes mellitus.

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Key result

Pre-existing diabetes in ACS is linked to ~84% higher three-year mortality than newly diagnosed diabetes.

P<0.001
n=11,870

Why the study?

Optimal HbA1c targets remain controversial in patients with newly diagnosed versus pre-existing diabetes mellitus following acute coronary syndrome.

Do clinical outcomes and optimal HbA1c targets differ between newly diagnosed and pre-existing diabetes mellitus patients after acute coronary syndrome?

Key Points

To evaluate clinical outcomes and optimal HbA1c target levels among acute coronary syndrome patients with newly diagnosed versus pre-existing diabetes mellitus.
Retrospective cohort analysis of 11,870 patients with acute coronary syndrome and diabetes mellitus from the Chang Gung Research Database between January 2005 and December 2019.
The population was categorized into newly diagnosed diabetes (N=6,089) and pre-existing diabetes (N=5,781) and evaluated across a three-year follow-up period.
Patients with pre-existing diabetes had higher rates of recurrent acute coronary syndrome, major bleeding, cardiovascular events, and all-cause mortality over three years compared to newly diagnosed patients.
Peak risk for recurrent acute coronary syndrome and cardiovascular mortality occurred at an HbA1c level of 6.6% in newly diagnosed diabetes, 6.7% in pre-existing diabetes, and 6.8% overall.
Peak risk for all-cause mortality was observed at an HbA1c of 7.0% in newly diagnosed diabetes, 8.2% in pre-existing diabetes, and 7.4% across the combined cohort.

Study Design

Type

Cohort (n=11,870)

Multicenter

Yes

Structured PICO

Do clinical outcomes and optimal HbA1c targets differ between newly diagnosed and pre-existing diabetes mellitus patients after acute coronary syndrome?

Population

11,870 adults with acute coronary syndrome and diabetes mellitus, followed for up to three years to compare outcomes between newly diagnosed and pre-existing diabetes.

Exposure

Pre-existing diabetes mellitus

Comparator

Newly diagnosed diabetes mellitus

Outcome

Clinical outcomes including recurrent acute coronary syndrome (ACS), major bleeding, cardiovascular (CV) events, and all-cause mortalityhard clinical

Main Result

Absolute Event Rate: 56.62% vs 30.69%

p-value: p=<0.001

Pre-existing diabetes mellitus is associated with worse clinical outcomes compared to newly diagnosed diabetes post-ACS, and maintaining consistently low HbA1c levels did not reduce re-ACS or enhance survival.

Limitations

Retrospective design relying on medical records and ICD codes, limiting causal inferences
Did not investigate the influence of varying severities of coronary artery disease or left ventricular function
Did not examine the effects of emerging DM treatments such as SGLT2 inhibitors and GLP1 receptor agonists
Excluded patients lacking baseline or subsequent HbA1c levels
Study population consisted primarily of East Asian individuals, limiting generalizability to other ethnic groups

Implication

Pre-existing DM was associated with worse post-ACS outcomes; leaves open whether diabetes duration should guide glycemic targets or secondary prevention.

Abstract

AIMS: This study aimed to evaluate clinical outcomes, including recurrent acute coronary syndrome (ACS) and mortality, in ACS patients with varying HbA1c levels, addressing the controversy over optimal targets in those with newly diagnosed and pre-existing diabetes mellitus (DM). METHODS: From January 2005 to December 2019, a total of 33,990 patients were identified with ACS in the Chang Gung Research Database based on their medical history. After excluding patients without DM and baseline or subsequent HbA1C data, a cohort of 11,870 DM patients was divided into two groups: one consisting of 6,089 patients with newly diagnosed DM and the other comprising 5,781 patients with pre-existing DM. RESULTS: During the three-year follow-up, the pre-existing DM group experienced worse clinical outcomes, such as increased rates of re-ACS, major bleeding, cardiovascular (CV) events, and all-cause mortality. Optimal HbA1c levels for mitigating re-ACS and/or CV mortality and all-cause mortality appeared to differ between the two DM cohorts. Re-ACS and CV mortality reached their highest at an HbA1c of 6.8% for all DM patients, 6.6% for newly diagnosed, and 6.7% for pre-existing cases. The greatest all-cause mortality risk was at an HbA1c of 7.4% for all DM patients, 7.0% in newly diagnosed, and 8.2% in pre-existing patients. CONCLUSION: Upon comparing newly diagnosed DM patients with those with pre-existing DM, a poorer prognosis was observed in the latter group, attributed to older age and a higher burden of comorbidities. Throughout the follow-up period, maintaining consistently low HbA1c levels did not reduce the incidence of re-ACS nor enhance survival rates.

Discussion

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Figures from the paper

Published by Current Vascular Pharmacology · CC BY

Cite This Study

Lee et al. (2025) conducted a cohort in Acute coronary syndrome and diabetes mellitus (n=11,870). Pre-existing diabetes mellitus vs. Newly diagnosed diabetes mellitus was evaluated on All-cause mortality at 3 years (p=<0.001). Pre-existing diabetes mellitus was associated with a significantly higher rate of all-cause mortality at three years compared to newly diagnosed diabetes in patients with acute coronary syndrome (56.62% vs. 30.69%).

synapsesocial.com/papers/6aa17af5e281d699e3ac7d37 https://doi.org/10.2174/0115701611322555250219111038

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Implication

Pre-existing DM was associated with worse post-ACS outcomes; leaves open whether diabetes duration should guide glycemic targets or secondary prevention.

Comparison of Clinical Outcomes between Newly Diagnosed and Pre-Existing Diabetes Mellitus Patients after Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Comparison of Clinical Outcomes between Newly Diagnosed and Pre-Existing Diabetes Mellitus Patients after Acute Coronary Syndrome

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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