Key result
Diabetic ACS patients are ~20% less likely to undergo PCI and receive less discharge DAPT.
Why the study?
Differences in clinical characteristics, treatment, and use of evidence-based medicines at discharge between diabetic and nondiabetic ACS patients were not well characterized in an Indian tertiary care setting.
Do clinical characteristics, risk factors, and management strategies differ between diabetic and nondiabetic patients presenting with acute coronary syndrome?
Observational (n=100)
No
Do clinical characteristics, risk factors, and management strategies differ between diabetic and nondiabetic patients presenting with acute coronary syndrome?
Absolute Event Rate: 85.7% vs 95.8%
p-value: p=< 0.05
Diabetic patients with acute coronary syndrome present with a higher burden of cardiometabolic risk factors but are less likely to undergo PCI or receive guideline-directed dual antiplatelet therapy and beta-blockers at discharge compared to nondiabetics.
Diabetics with ACS may face care gaps at discharge; leaves open whether targeted interventions improve outcomes in this subgroup.
OBJECTIVES: To compare clinical characteristics, treatment, and utilization of evidence-based medicines at discharge from hospital in acute coronary syndrome (ACS) patients with or without diabetes at a tertiary care cardiac center in India. METHODS: We performed an observational study in consecutive patients discharged following management of ACS. We obtained demographic details, comorbid conditions, and cardiovascular risk factors, physical and biochemical parameters, and management. Descriptive statistics are reported. RESULTS: We enrolled 100 patients (diabetics = 28) with mean age of 59.0 ± 10.8 years (diabetics 59.3 ± 11.6, nondiabetics 58.9 ± 8.5). Forty-nine patients had ST-elevation myocardial infarction (STEMI) (diabetics = 14, 28.7%) while 51 had nonSTEMI/unstable angina (diabetics = 14, 27.4%) (P = nonsignificant). Among diabetics versus nondiabetics there was greater prevalence (%) of hypertension (78.6% vs. 44.4%), obesity (25.0% vs. 8.3%), abdominal obesity (85.7% vs. 69.4%) and sedentary activity (89.2% vs. 77.8%), and lower prevalence of smoking/tobacco use (10.7% vs. 25.0%) (P < 0.05). In STEMI patients 28 (57.1%) were thrombolysed (diabetes 17.8% vs. 31.9%), percutaneous coronary interventions (PCI) was in 67.8% diabetics versus 84.7% nondiabetics and coronary bypass surgery in 21.4% versus 8.3%. At discharge, in diabetics versus nondiabetics, there was similar use of angiotensin converting enzyme inhibitors (67.9% vs. 69.4%) and statins (100.0% vs. 98.6%) while use of dual antiplatelet therapy (85.7% vs. 95.8%) and beta-blockers (64.3% vs. 73.6%) was lower (P < 0.05). CONCLUSIONS: Diabetic patients with ACS have greater prevalence of cardiometabolic risk factors (obesity, abdominal obesity, and hypertension) as compared to nondiabetic patients. Less diabetic patients undergo PCIs and receive lesser dual anti-platelet therapy and beta-blockers.
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Sharma et al. (2016) conducted an observational in acute coronary syndrome (n=100). Diabetes vs. No diabetes was evaluated on Dual antiplatelet therapy at discharge (p=< 0.05). Diabetic patients with ACS were less likely to undergo PCI (67.8% vs 84.7%) and receive dual antiplatelet therapy at discharge (85.7% vs 95.8%, P<0.05) compared to nondiabetic patients.
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