Copyright © 2000 by the European Society of Cardiology.
Influence of diabetes mellitus on clinical outcomes across the spectrum of acute coronary syndromes. Findings from the GUSTO-IIb Study
a The Duke Clinical Research Institute, Durham, North Carolina, U.S.A.
b Sahlgrenska Hospital, Göteborg, Sweden
c The Cleveland Clinic Foundation, Cleveland, Ohio, U.S.A.
d Green Lane Hospital, Auckland, New Zealand
e Università deglia Studi de Pavia, Pavia, Italy
revised June 6, 2000; accepted June 7, 2000
Abstract
Aims We examined the characteristics, outcomes, and effects of hirudin vs heparin treatment of diabetic patients across the spectrum of acute coronary syndromes.
Methods and Results We studied the 12142 patients enrolled in the randomized GUSTO-IIb study. Diabetic patients (n=2175) were older, more often female, more often had prior cardiovascular disease, hypertension, and hyperlipidaemia, and less often were current smokers. Diabetic patients had a higher overall incidence of death or (re)infarction at 30 days (13·1% vs 8·5%, P=0·0001), whether they presented with ST-segment elevation (13·9% vs 9·9%, P=0·0017) or not (12·8% vs 7·8%,P =0·0001), and at 6 months (18·8% vs 11·4%, P=0·0001). Among diabetic patients, hirudin was associated with a tendency toward a lower risk of death or (re)infarction at 30 days (12·2% vs 13·9% with heparin) and 6 months (17·8% vs 20·2%). Diabetic patients had more major bleeding, stroke, heart failure, shock, atrioventricular block, and atrial arrhythmias, but no increased risk for ocular bleeding.
Conclusions Diabetic patients with acute coronary syndromes had worse 30-day and 6-month outcomes, particularly those without ST-segment elevation. The statistically non-significant trend toward improved outcomes with hirudin was similar among patients with and without diabetes, with a greater point estimate for the absolute difference in patients with diabetes.
Key Words: Unstable angina, myocardial infarction, diabetes mellitus, hirudin, heparin
f1 Correspondence: Darren K. McGuire, MD, Duke Clinical Research Institute, 7481 North Pavilion, P.O. Box 17969, Durham, NC 27715, U.S.A.
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