Comparison of Treatment and Outcome of Acute Coronary Syndrome in Patients With Versus Patients Without Diabetes Mellitus

Hasin, Tal; Hochadel, Matthias; Gitt, Anselm K.; Behar, Shlomo; Bueno, Héctor; Hasin, Yonathan

doi:10.1016/j.amjcard.2008.11.034

Cited by 59 publications

(47 citation statements)

References 17 publications

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“…It is well known that diabetes is an independent predictor of contrast-induced nephropathy and patients with DM had significantly higher 1-year mortality [16,17] . In our patients, 80% of AKI patients were diabetic and diabetes increased the risk for AKI 7.4-fold and the risk for postoperative infection and death 6.9-fold compared to nondiabetic patients.…”

Section: Discussionmentioning

confidence: 99%

Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery

Shavit¹,

Dolgoker²,

Ivgi

et al. 2011

Kidney Blood Press Res

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Introduction: We tested the hypothesis that urinary and serum neutrophil gelatinase-associated lipocalins (NGAL) early after non-cardiac major surgery predict postoperative acute kidney injury (AKI), complications and mortality. Methods: We studied 74 patients undergoing orthopedic, vascular and abdominal surgery lasting ≧2 h. NGAL was measured in preoperative, as well as 2- and 6-hour postoperative samples. The primary outcome was AKI. Secondary outcome was postoperative infection and death. Results: 10 patients (13.5%) developed AKI, 19 (26%) reached secondary outcomes, of whom 5 (7%) died. Serum NGAL was significantly higher in patients with diabetes and chronic kidney disease (CKD). No significant correlation was detected between serum or urine NGAL and subsequent development of AKI. Urine NGAL at 6 h and serum NGAL at 2 and 6 h were strongly correlated with postoperative infection and death (p = 0.004, p = 0.013 and p = 0.001, respectively). Conclusions: Our data suggest that in the general surgical population, NGAL could serve as a potent early biomarker for postoperative infection, and that the presence of CKD and diabetes mellitus is associated with higher levels of NGAL and may influence its predictive value.

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Section: Discussionmentioning

confidence: 99%

Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery

Shavit¹,

Dolgoker²,

Ivgi

et al. 2011

Kidney Blood Press Res

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“…Mortality is increased twice against the background of this metabolic disorder. 10 However, according to data from records, diabetic patients with ACS are less frequently subjected to revascularization in any form and are rarely prescribed thienopyridines or GP IIb/ IIIa inhibitors. 10,11 Patients with DM represent a group at a high risk of developing cardiovascular disease.…”

Section: Discussionmentioning

confidence: 99%

“…10 However, according to data from records, diabetic patients with ACS are less frequently subjected to revascularization in any form and are rarely prescribed thienopyridines or GP IIb/ IIIa inhibitors. 10,11 Patients with DM represent a group at a high risk of developing cardiovascular disease. According to European Society of Cardiology guidelines for the management of NSTEMI from 2011, presence of DM against the background of UA/NSTEMI necessitates invasive examination and possible revascularization within the fi rst 72 hours after hospitalization even in the absence of dynamics in the ST segment or positive markers of myocardial necrosis.…”

Section: Discussionmentioning

confidence: 99%

Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

Dimitrov

Симова²,

Mateev³

et al. 2013

Folia Medica

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INTRODUCTION: Patients with acute coronary syndrome without ST segment elevation are a heterogeneous group with respect to the risk of having a major adverse cardiac event (MACE). A history of diabetes mellitus (DM) is no doubt one of the factors that defi ne a patient as being at a higher risk of having the syndrome. AIM: To compare early invasive strategy with selective invasive strategy indicated for patients with and without DM. PATIENTS AND METHODS: The study enrolled 178 patients with unstable angina or non-ST elevation myocardial infarction (UA/NSTEMI), and of these 52 (29.2%) had DM. Patients were randomly assigned to an early invasive strategy (these were scheduled to undergo coronary arteriography and percutaneous coronary intervention within 24 hours after admission) or to a selective invasive strategy (at fi rst these were medically stabilized, with coronary arteriography required only in case of angina recurrence and/or evidence of inducible myocardial ischemia). The patients were followed up for a mean period of 22.8 ± 14 months. RESULTS: In the follow up the diabetics allocated to an early invasive strategy were found to have a signifi cantly lower angina recurrence incidence (p = 0.005), rehospitalization rate (p = 0.001), fewer arteriographies (p = 0.001) and coronary interventions (p = 0.001) and low cumulative incidence of MACE (p = 0.008) in comparison with the diabetics assigned to selective invasive strategy. We also found, using the Kaplan-Meier curves survival analysis, that the time to MACE in patients assigned to an early invasive strategy was signifi cantly longer than that in the group of selective invasive strategy. In the follow-up of non-diabetics we found no signifi cant difference in MACE rate between the patients allocated to early invasive strategy and those assigned to selective invasive strategy. In the selective invasive strategy group, however, the cardiovascular adverse events tended to occur earlier than in the early invasive strategy group. CONCLUSIONS: Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndrome is associated with a reduced MACE rate compared with the selective invasive strategy used in these patients. Early invasive strategy applied in diabetic patients is also associated with a signifi cantly longer time to MACE. In non-diabetics the advantages of early over selective invasive strategy are not so clearly differentiated.

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“…The classic symptom of ACS is chest pain or tightness, although many people (particularly women, the elderly and those with diabetes mellitus) may present with atypical pain or no pain at all. [2][3][4] Other symptoms may include breathlessness, sweating and nausea. [2][3][4] The underlying cause of ACS is build-up of atheroma within the wall of the coronary artery.…”

Section: Description Of Health Problemmentioning

confidence: 99%

“…[2][3][4] Other symptoms may include breathlessness, sweating and nausea. [2][3][4] The underlying cause of ACS is build-up of atheroma within the wall of the coronary artery. This occurs over a number of years and is generally asymptomatic.…”

Section: Description Of Health Problemmentioning

confidence: 99%

Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

Greenhalgh

Bagust

Boland

et al. 2015

Health Technology Assessment

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BackgroundAcute coronary syndromes (ACSs) are life-threatening conditions associated with acute myocardial ischaemia. There are three main types of ACS: ST segment elevation myocardial infarction (STEMI), non-ST segment elevation myocardial infarction (NSTEMI) and unstable angina (UA). One treatment for ACS is percutaneous coronary intervention (PCI) plus adjunctive treatment with antiplatelet drugs. Dual therapy antiplatelet treatment [aspirin plus either prasugrel (Efient®, Daiichi Sankyo Company Ltd UK/Eli Lilly and Company Ltd), clopidogrel or ticagrelor (Brilique®, AstraZeneca)] is standard in UK clinical practice. Prasugrel is the focus of this review.ObjectivesThe remit is to appraise the clinical effectiveness and cost-effectiveness of prasugrel within its licensed indication for the treatment of ACS with PCI and is a review of National Institute for Health and Care Excellence technology appraisal TA182.Data sourcesFour electronic databases (MEDLINE, EMBASE, The Cochrane Library, PubMed) were searched from database inception to June 2013 for randomised controlled trials (RCTs) and to August 2013 for economic evaluations comparing prasugrel with clopidogrel or ticagrelor in ACS patients undergoing PCI.MethodsClinical outcomes included non-fatal and fatal cardiovascular (CV) events, adverse effects of treatment and health-related quality of life (HRQoL). Cost-effectiveness outcomes included incremental cost per life-year gained and incremental cost per quality-adjusted life-year (QALY) gained. An independent economic model assessed four mutually exclusive subgroups: ACS patients treated with PCI for STEMI and with and without diabetes mellitus and ACS patients treated with PCI for UA or NSTEMI and with and without diabetes mellitus.ResultsNo new RCTs were identified beyond that reported in TA182. TRITON-TIMI 38 (Trial to Assess Improvement in Therapeutic Outcomes by Optimizing Platelet Inhibition with Prasugrel Thrombolysis in Myocardial Infarction 38) compared prasugrel with clopidogrel in ACS patients scheduled for PCI. No relevant economic evaluations were identified. Our analyses focused on a key subgroup of patients: those aged < 75 years who weighed > 60 kg (no previous stroke or transient ischaemic attack). For the primary composite end point (death from CV causes, non-fatal myocardial infarction or non-fatal stroke) statistically significantly fewer events occurred in the prasugrel arm (8.3%) than in the clopidogrel arm (11%). No statistically significant difference in major bleeding events was noted. However, there was a significant difference in favour of clopidogrel when major and minor bleeding events were combined (3.0 vs. 3.9%). No conclusions could be drawn regarding HRQoL. The results of sensitivity analyses confirmed that it is likely that, for all four ACS subgroups, within 5–10 years prasugrel is a cost-effective treatment option compared with clopidogrel at a willingness-to-pay threshold of £20,000 to £30,000 per QALY gained. At the full 40-year time horizon, all estimates are < £10,000 per QALY gained.LimitationsLack of data precluded a clinical comparison of prasugrel with ticagrelor; the comparative effectiveness of prasugrel compared with ticagrelor therefore remains unknown. The long-term modelling exercise is vulnerable to major assumptions about the continuation of early health outcome gains.ConclusionA key strength of the review is that it demonstrates the cost-effectiveness of prasugrel compared with clopidogrel using the generic price of clopidogrel. Although the report demonstrates the cost-effectiveness of prasugrel compared with clopidogrel at a threshold of £20,000 to £30,000 per QALY gained, the long-term modelling is vulnerable to major assumptions regarding long-term gains. Lack of data precluded a clinical comparison of prasugrel with ticagrelor; the comparative effectiveness of prasugrel compared with ticagrelor therefore remains unknown. Well-audited data are needed from a long-term UK clinical registry on defined ACS patient groups treated with PCI who receive prasugrel, ticagrelor and clopidogrel.Study registrationThis study is registered as PROSPERO CRD42013005047.FundingThe National Institute for Health Research Health Technology Assessment programme.

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Comparison of Treatment and Outcome of Acute Coronary Syndrome in Patients With Versus Patients Without Diabetes Mellitus

Cited by 59 publications

References 17 publications

Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery

Neutrophil Gelatinase-Associated Lipocalin as a Predictor of Complications and Mortality in Patients Undergoing Non-Cardiac Major Surgery

Timing of Invasive Strategy in Diabetic and Non-Diabetic Patients with Non-St-Segment Elevation Acute Coronary Syndrome

Prasugrel (Efient®) with percutaneous coronary intervention for treating acute coronary syndromes (review of TA182): systematic review and economic analysis

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