TY - JOUR
T1 - Underuse of evidence-based treatment partly explains the worse clinical outcome in diabetic patients with acute coronary syndromes
AU - Yan, Raymond T.
AU - Yan, Andrew T.
AU - Tan, Mary
AU - McGuire, Darren K
AU - Leiter, Lawrence
AU - Fitchett, David H.
AU - Lauzon, Claude
AU - Lai, Kevin
AU - Chow, Chi Ming
AU - Langer, Anatoly
AU - Goodman, Shaun G.
N1 - Funding Information:
This research was sponsored by the Canadian Heart Research Centre and Key Pharmaceuticals, Division of Schering Canada Inc. Drs Fitchett, Lauzon, Lai, Langer, and Goodman have received research grant support and speaker/consultant honoraria from Schering Canada Inc. Dr McGuire has received research grant support and speaker/consultant honoraria from Pfizer, GlaxoSmithKline, Wyeth, Sanofi-Aventis, Guilford, and Takeda. Dr Andrew Yan is supported by the Canadian Institutes of Health Research Fellowship Award, the Canadian Heart Research Centre Fellowship, and the Detweiler Travelling Fellowship.
PY - 2006/10
Y1 - 2006/10
N2 - Background: Diabetes-related differences in treatment and clinical outcome of patients across the entire spectrum of acute coronary syndromes (ACSs) have potential clinical implications but have not been well studied. Methods: The multicenter, prospective, Canadian ACS Registry enrolled 4578 patients hospitalized for ACS between 1999 and 2001 across 9 provinces in Canada. We compared baseline characteristics, in-hospital and post-discharge treatments, and clinical outcome of diabetic and non-diabetic patients. The impact of diabetes on use of thrombolytic therapy and coronary revascularization; and the independent association between diabetes, treatments, and diabetes-treatment interactions on outcome were examined. Results: Diabetic patients with ACS had more cardiovascular risk factors and higher-risk clinical presentation. They paradoxically received less evidence-based medications in-hospital, at discharge, and at 1-year. Although diabetes independently predicted higher 1-year mortality (OR 1.47, 95% CI 1.15-1.87; P = .002) after adjustment for validated prognosticators, it was also an independent predictor of not receiving thrombolytic therapy (OR 0.72, 95% CI 0.54-0.95; P = .021) and coronary revascularization (OR 0.69, 95% CI 0.59-0.82; P < .001). These underused therapies were all independently associated with reduced 1-year mortality, with no significant diabetes-related treatment-outcome heterogeneity. Importantly, diabetes remained an independent adverse prognosticator even after further adjustment for these differences in treatment. Conclusions: Evidence-based therapies are underused in the contemporary management of diabetic patients with ACS, which partly explains their worse outcome. Diabetes should be considered a high-risk feature in ACS risk stratification that encourages more intensive treatments. Continued efforts to promote adherence to existing proven therapies and to develop novel treatment strategies targeting diabetes-specific cardiovascular pathophysiology are imperative to improve their adverse prognosis.
AB - Background: Diabetes-related differences in treatment and clinical outcome of patients across the entire spectrum of acute coronary syndromes (ACSs) have potential clinical implications but have not been well studied. Methods: The multicenter, prospective, Canadian ACS Registry enrolled 4578 patients hospitalized for ACS between 1999 and 2001 across 9 provinces in Canada. We compared baseline characteristics, in-hospital and post-discharge treatments, and clinical outcome of diabetic and non-diabetic patients. The impact of diabetes on use of thrombolytic therapy and coronary revascularization; and the independent association between diabetes, treatments, and diabetes-treatment interactions on outcome were examined. Results: Diabetic patients with ACS had more cardiovascular risk factors and higher-risk clinical presentation. They paradoxically received less evidence-based medications in-hospital, at discharge, and at 1-year. Although diabetes independently predicted higher 1-year mortality (OR 1.47, 95% CI 1.15-1.87; P = .002) after adjustment for validated prognosticators, it was also an independent predictor of not receiving thrombolytic therapy (OR 0.72, 95% CI 0.54-0.95; P = .021) and coronary revascularization (OR 0.69, 95% CI 0.59-0.82; P < .001). These underused therapies were all independently associated with reduced 1-year mortality, with no significant diabetes-related treatment-outcome heterogeneity. Importantly, diabetes remained an independent adverse prognosticator even after further adjustment for these differences in treatment. Conclusions: Evidence-based therapies are underused in the contemporary management of diabetic patients with ACS, which partly explains their worse outcome. Diabetes should be considered a high-risk feature in ACS risk stratification that encourages more intensive treatments. Continued efforts to promote adherence to existing proven therapies and to develop novel treatment strategies targeting diabetes-specific cardiovascular pathophysiology are imperative to improve their adverse prognosis.
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U2 - 10.1016/j.ahj.2006.04.002
DO - 10.1016/j.ahj.2006.04.002
M3 - Article
C2 - 16996832
AN - SCOPUS:33748761642
SN - 0002-8703
VL - 152
SP - 676
EP - 683
JO - American heart journal
JF - American heart journal
IS - 4
ER -