Key result
Diabetes is linked to a ~22% lower rate of coronary angiography following ACS.
Why the study?
Guidelines recommend an early invasive strategy for patients with diabetes with ACS, but it is unclear if they receive coronary angiography and revascularisation to the same extent as patients without diabetes.
Does the presence of diabetes reduce the likelihood of undergoing coronary angiography and revascularization in patients with first-time acute coronary syndrome?
Cohort (n=24,952)
Yes
Does the presence of diabetes reduce the likelihood of undergoing coronary angiography and revascularization in patients with first-time acute coronary syndrome?
Hazard Ratio: 0.78 (95% CI 0.74–0.82)
Absolute Event Rate: 64% vs 74%
p-value: p=<0.0001
Despite guideline recommendations for an early invasive strategy, patients with diabetes and incident ACS are significantly less likely to undergo coronary angiography and subsequent revascularization compared to those without diabetes.
Diabetes-associated lower angiography rates in ACS may signal disparities; leaves open whether this reflects bias or appropriate selection, warranting prospective study.
BACKGROUND: Guidelines recommend an early invasive strategy for patients with diabetes with acute coronary syndromes (ACS). We investigated if patients with diabetes with ACS are offered coronary angiography (CAG) and revascularisation to the same extent as patients without diabetes. METHODS AND RESULTS: The study is a nationwide cohort study linking Danish national registries containing information on healthcare. The study population comprises all patients hospitalised with first-time ACS in Denmark during 2005-2007 (N=24 952). Diabetes was defined as claiming of a prescription for insulin and/or oral hypoglycaemic agents within 6 months prior to the ACS event. Diabetes was present in 2813 (11%) patients. Compared with patients without diabetes, patients with diabetes were older (mean 69 vs 67 years, p<0.0001), less often males (60% vs 64%, p=0.0001) and had more comorbidity. Fewer patients with diabetes underwent CAG: cumulative incidence 64% vs 74% for patients without diabetes, HR=0.72 (95% CI 0.69 to 0.76, p<0.0001); adjusted for age, sex, previous revascularisation and comorbidity HR=0.78 (95% CI 0.74 to 0.82, p<0.0001). More patients with diabetes had CAG showing two-vessel or three-vessel disease (53% vs 38%, p<0.0001). However, revascularisation after CAG revealing multivessel disease was less likely in patients with diabetes (multivariable adjusted HR=0.76, 95% CI 0.68 to 0.85, p<0.0001). CONCLUSIONS: In this nationwide cohort of patients with incident ACS, patients with diabetes were found to be less aggressively managed by an invasive treatment strategy. The factors underlying the decision to defer an invasive strategy in patients with diabetes are unclear and merit further investigation.
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Hvelplund et al. (2015) conducted a cohort in Acute coronary syndrome (n=24,952). Diabetes mellitus vs. Patients without diabetes was evaluated on Coronary angiography within 60 days (HR 0.78, 95% CI 0.74 to 0.82, p=<0.0001). Patients with diabetes hospitalized with acute coronary syndrome were significantly less likely to undergo coronary angiography compared to patients without diabetes (adjusted HR 0.78).
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