Diabetes and Mortality in Acute Coronary Syndrome: Findings from the Gulf COAST Registry

Author(s): Abdulla Shehab*, Akshaya Srikanth Bhagavathula, Khalid Al-Rasadi, Fayez Alshamsi, Juma Al Kaab, Khalid Bin Thani, Ridha Mustafa

Journal Name: Current Vascular Pharmacology

Volume 18 , Issue 1 , 2020

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Graphical Abstract:


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.

Aims: 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.

Conclusion: 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.

Selvin E, Parrinello CM, Sacks DB, et al. Trends in prevalence and control of diabetes in the United States 1988-1994 and 1999-2010. Ann Intern Med 2014; 160: 512-25.
Lam DW, LeRoith D. The worldwide diabetes epidemic. Curr Opin Endocrinol Diabetes Obes 2012; 19: 93-6.
Danaei G, Finucane MM, Lu Y, et al. National, regional, and global trends in fasting plasma glucose and diabetes prevalence since 1980: Systematic analysis of health examination surveys and epidemiological studies with 370 country-years and 2.7 million participants. Lancet 2011; 378: 31-40.
Zhou B, Lu Y, Hajifathalian K. Worldwide trends in diabetes since 1980: A pooled analysis of 751 population-based studies with 4.4 million participants. Lancet 2016; 387: 1513-30.
Khan Y, Hamdy O. Type 2 diabetes in the middle east and north africa (MENA). In: Dagogo-Jack, Sam (Ed.)Diabetes mellitus in developing countries and underserved communities. Springer International Publishing 2017; pp. 49-61.
Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA 2003; 290: 898-904.
Anselmino M, Mellbin L, Wallander M, et al. Early detection and integration management of dysglycemia in cardiovascular disease: A key factor for decreasing the likelihood of future events. Rev Cardiovasc Med 2008; 9: 29-38.
Arnold SV, Lipska KJ, Li Y, et al. Prevalence of glucose abnormalities among patients presenting with an acute myocardial infarction. Am Heart J 2014; 168: 466-70.
Chen PC, Chua SK, Hung HF, et al. Admission hyperglycemia predicts poorer short- and long-term outcomes after primary percutaneous coronary intervention for ST-elevation myocardial infarction. J Diabetes Investig 2014; 5: 80-6.
Kuramitsu S, Yokoi H, Domei T, et al. Impact of post-challenge hyperglycemia on clinical outcomes in Japanese patients with stable angina undergoing percutaneous coronary intervention. Cardiovasc Diabetol 2013; 12: 74.
Lee TF, Burt MG, Heilbronn LK, et al. Relative hyperglycemia is associated with complications following an acute myocardial infarction: A post-hoc analysis of HI-5 data. Cardiovasc Diabetol 2017; 16: 157.
Donahoe SM, Steward GC, McCabe CH, et al. Diabetes and mortality following acute coronary syndrome. JAMA 2007; 298: 765-75.
Aggarwal B, Shah GK, Randhawa M, et al. Utility of glycated hemoglobin for assessment of glucose metabolism in patients with ST-segment elevation myocardial infarction. Am J Cardiol 2016; 117: 749-53.
Kim EJ, Jeong MH, Kim JH, et al. Clinical impact of admission hyperglycemia on in-hospital mortality in acute myocardial infarction patients. Int J Cardiol 2017; 236: 9-15.
Gholap NN, Achana FA, Davies MJ, et al. Long‐term mortality after acute myocardial infarction among individuals with and without diabetes: A systematic review and meta‐analysis of studies in the post‐reperfusion era. Diabetes Obes Metab 2017; 19: 364-74.
Cubbon RM, Abbas A, Wheatcroft SB, et al. Diabetes mellitus and mortality after acute coronary syndrome as a first or recurrent cardiovascular event. PLoS One 2008; 3e3483
Deedwania P, Kosiborod M, Barrett E, et al. Hyperglycemia and acute coronary syndrome. A scientific statement from the American heart association diabetes committee of the council on nutrition, physical activity, and metabolism. Circulation 2008; 117: 1610-9.
Arnold SV, Lipska KJ, Inzucchi SE, et al. The reliability of in-hospital diagnoses of diabetes mellitus in the setting of an acute myocardial infarction. BMJ Open Diabetes Res Care 2014; 2e000046
Colombo MG, Meisinger C, Amann U, et al. Association of obesity and long-term mortality in patients with acute myocardial infarction with and without diabetes mellitus: results from the MONICA/KORA myocardial infarction registry. Cardiovasc Diabetol 2015; 14: 24.
Zubaid M, Thani KB, Rashed W, et al. Design and rationale of Gulf locals with acute coronary syndrome events (Gulf Coast) registry. Open Cardiovasc Med J 2014; 8: 88-93.
Ali MK, Bullard KM, Saaddine JB, et al. Achievement of goals in US diabetes care, 1999-2010. N Engl J Med 2013; 368: 1613-24.
Al-Rasadi K, Al-Zakwani I, Alsheikh-Ali AA, et al. Prevalence, management, and outcomes of familial hypercholesterolemia in patients with acute coronary syndromes in the Arabian Gulf. J Clin Lipidol 2018; 12: 685-92.
Khesroh AA, Al-Roumi F, Al-Zakwani I, et al. Gender differences among patients with acute coronary syndrome in the Middle East. Heart Views 2017; 18: 77.
Zubaid M, Rashed W, Alsheikh-Ali AA, et al. Disparity in ST-segment elevation myocardial infarction practices and outcomes in Arabian Gulf countries (Gulf COAST Registry). Heart Views 2017; 18: 41.
Shore S, Borgerding JA, Gylys-Colwell I, et al. Association between hyperglycemia at admission during hospitalization for acute myocardial infarction and subsequent diabetes: Insights from the veterans administration cardiac care follow-up clinical study. Diabetes Care 2014; 37: 409-18.
Beck JA, Mesinger C, Heier M, et al. Effect of blood glucose concentration on admission in non-diabetic versus diabetic patients with first acute myocardial infarction on short-and long-term mortality (from the MONICA/KORA Augsburg myocardial infarction registry). Am J Cardiol 2009; 109: 1607-12.
Karamat MA, Raja UY, Manley SE, et al. Prevalence of undiagnosed type 2 diabetes in patients admitted with acute coronary syndrome: The utility of easily reproducible screening methods. BMC Endocr Disord 2017; 17: 3.
Stolker JM, Spertus JA, McGuire DK, et al. Relationship between glycosylated hemoglobin assessment and glucose therapy intensification in patients with diabetes hospitalized for acute myocardial infarction. Diabetes Care 2012; 35: 991-3.
Ritsinger V, Malmberg K, Mårtensson A, et al. Intensified insulin-based glycaemic control after myocardial infarction: mortality during 20-year follow-up of the randomised Diabetes Mellitus Insulin Glucose Infusion in Acute Myocardial Infarction (DIGAMI 1) trial. Lancet Diabetes Endocrinol 2014; 2: 627-33.
Zhao S, Murugiah K, Li Na, et al. Admission glucose and in-hospital mortality after acute myocardial infarction in patients with or without diabetes: A cross-sectional study. Chin Med J (Engl) 2017; 130: 767-75.
Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction. Circulation 2005; 111: 3078-86.
Wei CC, Shyu KG, Cheng JJ, et al. Diabetes and adverse cardiovascular outcomes in patients with acute coronary syndrome-data from Taiwan’s acute coronary syndrome full spectrum data registry. Acta Cardiol Sin 2016; 32: 31-8.
Khan SS, Ning H, Wilkins JT, et al. Association of body mass index with lifetime risk of cardiovascular disease and compression of morbidity. JAMA Cardiol 2018; 3: 280-7.
Cheung NW, Wong VW, McLean M. The Hyperglycemia: Intensive insulin infusion in infarction (HI-5) study: A randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care 2006; 29: 765-70.
Pfeffer MA, Claggett B, Diaz R, et al. Lixisenatide in patients with type 2 diabetes and acute coronary syndrome. N Engl J Med 2015; 373: 2247-57.
Marso SP, Daniels GH, Brown-Frandsen K, et al. Liraglutide and cardiovascular outcomes in type 2 diabetes. N Engl J Med 2016; 375: 311-22.
Zinman B, Wanner C, Lachin JM, et al. Empagliflozin, cardiovascular outcomes, and mortality in type 2 diabetes. N Engl J Med 2015; 373: 2117-28.
Lloyd-Jones DM, Morris PB, Ballantyne CM, et al. 2017 Focused update of the 2016 ACC expert consensus decision pathway on the role of non-statin therapies for LDL-cholesterol lowering in the management of atherosclerotic cardiovascular disease risk: A report of the American college of cardiology task force on expert consensus decision pathways. J Am Coll Cardiol 2017; 70: 1785-822.
Handelsman Y, Lepor NE. PCSK9 Inhibitors in lipid management of patients with diabetes mellitus and high cardiovascular risk: A review. J Am Heart Assoc 2018; 7e008953
Murphy SA, Cannon CP, Blazing MA, et al. Reduction in total cardiovascular events with ezetimibe/simvastatin post-acute coronary syndrome: The IMPROVE-IT trial. J Am Coll Cardiol 2016; 67: 353-61.
Giugliano RP, Keech A, Murphy SA, et al. Clinical efficacy and safety of evolocumab in high-risk patients receiving a statin: secondary analysis of patients with low LDL cholesterol levels and in those already receiving a maximal-potency statin in a randomized clinical trial. JAMA Cardiol 2017; 2: 1385-91.
Goodman SG, Schwartz G, Bhatt DL, et al. Use of high-intensity statin therapy post-acute coronary syndrome in the ongoing ODYSSEY OUTCOMES trial of alirocumab, a proprotein convertase subtilisin/kexin type 9 monoclonal antibody, versus placebo: Interim baseline data. J Am Coll Cardiol 2017; 69: 153.
Masmiquel L, Leiter LA, Vidal J, et al. LEADER 5: Prevalence and cardiometabolic impact of obesity in cardiovascular high-risk patients with type 2 diabetes mellitus: Baseline global data from the LEADER trial. Cardiovasc Diabetol 2016; 15: 29.
Fitchett D, Zinman B, Wanner C, et al. Heart failure outcomes with empagliflozin in patients with type 2 diabetes at high cardiovascular risk: results of the EMPA-REG OUTCOME trial. Eur Heart J 2016; 37: 1526-34.
Katsiki N, Purrello F, Tsioufis C, et al. Cardiovascular disease prevention strategies for type 2 diabetes mellitus. Expert Opin Pharmacother 2017; 18: 1243-60.

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Year: 2020
Page: [68 - 76]
Pages: 9
DOI: 10.2174/1570161116666181024094337
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