What is the clinical evidence from this study?

Study design: Cohort. Population: NSTEMI (n=2928). Intervention: Diabetes mellitus vs. No diabetes. Primary outcome: 30-day mortality (p=0.025).

What does this research mean for the field?

Patients with diabetes admitted for NSTEMI have worse clinical presentations and higher 30-day mortality than those without diabetes, despite receiving a similar quality of guideline-recommended care. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

January 8, 2024Open Access

Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology

Key Result

Patients with diabetes admitted for NSTEMI had higher 30-day mortality than those without diabetes (3.3% vs. 2.0%, P=0.025), despite receiving similar quality of care.

Study Design

Type

Cohort (n=2,928)

Multicenter

Yes

Structured PICO

Does prior diabetes mellitus worsen clinical presentation and outcomes in patients admitted with NSTEMI?

Population

2,928 patients admitted to hospital with NSTEMI (1,104 with prior diabetes, 1,824 without) from 287 centres in 59 countries.

Intervention

Prior diabetes mellitus (observational exposure)

Comparator

No prior diabetes mellitus

Outcome

In-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding, death, and 30-day mortalityhard clinical

NSTEMI patients with diabetes have significantly worse in-hospital and 30-day outcomes compared to those without, highlighting a critical need for better utilization of cardiovascular-protective glycaemic agents like SGLT2 inhibitors and GLP-1 receptor agonists.

Main Result

Absolute Event Rate: 3.3% vs 2%

p-value: p=0.025

Abstract

AIMS: Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status. METHODS AND RESULTS: Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation. CONCLUSION: NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.

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