Background: The prevalence of traditional risk factors such as diabetes mellitus (DM) and
obesity are increasing in patients with acute coronary syndrome (ACS). Furthermore, outcomes after
ACS are worse in patients with DM. The high prevalence of DM and an early age at onset of ACS have
been described in prior publications from the Gulf Coast Database.
Aim: We aimed to define the effect of DM on total mortality following ACS presentation at 30-days and
1 year based on the Gulf COAST registry database.
Methods: The Gulf COAST registry is a prospective, multinational, longitudinal, observational cohort
study conducted among Gulf citizens admitted with a diagnosis of ACS. The outcomes among patients
with DM following ACS were stratified into 2 groups based on their DM status. Cumulative survival
stratified by groups and subgroup categories was assessed by the Kaplan-Meier method.
Results: Of 3,576 ACS patients, 2,730 (76.3%) presented with non ST-segment elevation myocardial
infarction (NSTEMI) and 846 (23.6%) with STEMI. Overall, 1906 patients (53.3%) had DM. A significantly
higher in-hospital (4.8%), 30-day (6.7%) and 1-year (13.7%) mortality were observed in patients
with DM compared with those without DM. The Kaplan-Meier survival curve showed significant differences
in survival of ACS patients with or without DM, with a short period of time-to-event for DM
patients with STEMI (30-days) and the longest (1-year) for NSTEMI patients without DM.
Conclusions: DM patients presenting with ACS-STEMI have poor short-term outcomes while DMNSTEMI
patients have poor long-term outcomes. This highlights the need for strategies to evaluate DM
control and integration of care to control vascular risk among this high-risk population.
Keywords: Diabetes mellitus, acute coronary syndrome, ST-segment elevation myocardial infarction, mortality, cardiovascular diseases, Middle East
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