Usefulness of Diabetes Mellitus to Predict Long-Term Outcomes in Patients With Unstable Angina Pectoris

Michael E. Farkouh, Ashish Aneja, Guy S. Reeder, Peter A. Smars, Ryan J. Lennon, Heather J. Wiste, Kay Traverse, Louai Razzouk, Ananda Basu, David R. Holmes, Verghese Mathew

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8 Scopus citations

Abstract

The objective of this study was to determine short- and long-term cardiovascular outcomes in unselected patients with diabetes mellitus (DM) with acute ischemic chest pain (AICP). In patients with DM presenting to the emergency department with AICP, short-term cardiovascular outcomes remain discordant between trials and registries, whereas long-term outcomes are not well-described. A consecutive cohort of all residents of Olmsted County, Minnesota, presenting with AICP from January 1, 1985, to December 31, 1992, was followed for a median duration of 16.6 years. The primary outcome was long-term all-cause mortality. Other outcomes included a composite of death, myocardial infarction, stroke, and revascularization (major adverse cardiovascular and cerebrovascular events [MACCEs]) as well as heart failure (HF) events at 30 days and at a median of 7.3 years, respectively. Of the 2,271 eligible patients, 336 (14.8%) were classified with DM. The crude 30-day MACCE rate was 10.1% in patients with DM and 6.1% in those without DM (p = 0.007). HF events were more common in patients with DM at 30 days (9.8% vs 3.1%, p <0.001). At 7.3 years, patients with DM were more likely to experience MACCEs and HF events than those without DM (71.2% vs 45.1%, unadjusted hazard ratio 2.15%, 95% confidence interval 1.87 to 2.48, p <0.001, and 45.1% vs 18.2%, p <0.001, respectively). Over the follow-up period, 272 patients with DM (81.9%) died, compared with 936 (49.2%) without DM (p <0.001). In conclusion, DM is associated with a higher short-term risk for MACCEs and HF and a higher long-term risk for mortality in unselected patients with AICP. DM should be included as a high-risk variable in national acute coronary syndrome guidelines.

Original languageEnglish (US)
Pages (from-to)492-497
Number of pages6
JournalAmerican Journal of Cardiology
Volume104
Issue number4
DOIs
StatePublished - Aug 15 2009

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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    Farkouh, M. E., Aneja, A., Reeder, G. S., Smars, P. A., Lennon, R. J., Wiste, H. J., Traverse, K., Razzouk, L., Basu, A., Holmes, D. R., & Mathew, V. (2009). Usefulness of Diabetes Mellitus to Predict Long-Term Outcomes in Patients With Unstable Angina Pectoris. American Journal of Cardiology, 104(4), 492-497. https://doi.org/10.1016/j.amjcard.2009.04.007