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

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. Aim: 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.

The Role of Nicorandil in the Management of Chronic Coronary Syndromes in the Gulf Region

“…The Gulf locals with Acute Coronary Syndrome Events (Gulf COAST) registry, a prospective, multinational, longitudinal, observational cohort study of Gulf citizens admitted with a diagnosis of ACS provides contemporary evidence of the regional burden of DM on cardiovascular mortality [20]: 53.3% of patients with ACS had DM in whom in-hospital, 30-day and 1-year mortality were significantly higher compared to non-diabetics. Patients with angina and concomitant DM also represent a challenging group to manage as they typically have more diffuse and extensive CAD, coronary microvascular dysfunction, and a greater burden of symptomatic angina than those without DM [21][22][23].…”

Current gaps in management and timely referral of cardiorenal complications among people with type 2 diabetes mellitus in the Middle East and African countries: Expert recommendations

“…Microvascular complications, comprising nephropathy, neuropathy, and retinopathy, along with macrovascular complications, including coronary artery disease, peripheral artery disease, and cerebrovascular disease, are the major cause of mortality and morbidity in patients with T2DM 5,6 . Indeed, cardiovascular (CV) complications such as myocardial infarction (MI), atrial fibrillation, and chronic heart failure (CHF) occur a decade earlier in the MENA and AFR region than in other populations 7‐9 . To prevent CV‐related mortality in patients with T2DM, optimum management of cardiorenal risk factors and complications is crucial, along with glycemic control.…”

“… 5 , 6 Indeed, cardiovascular (CV) complications such as myocardial infarction (MI), atrial fibrillation, and chronic heart failure (CHF) occur a decade earlier in the MENA and AFR region than in other populations. 7 , 8 , 9 To prevent CV‐related mortality in patients with T2DM, optimum management of cardiorenal risk factors and complications is crucial, along with glycemic control. Screening programs for early detection of T2DM, compounded by timely utilization of safe and effective therapies, may help prevent complications, thus reducing morbidity and mortality.…”

Assessing different determinants influencing the death outcome resulting from acute coronary syndrome in patients treated in the coronary unit of the general hospital in Valjevo, and their differences

“…Kada je reč o arterijskoj hipertenziji, ona je vodeći uzrok prevremenih neželjenih kardioloških događaja i nosi dva do tri puta veći rizik ispitivanje uticaja različitih determinanti na smrtni ishod od akutnog koronarnog sindroma pacijenata lečenih u koronarnoj jedinici opšte bolnice u valjevu i njihove razlike assessing different determinants influencing the death outcome resulting from acute coronary syndrome in patients treated in the coronary unit of the general hospital in valjevo, and their differences greater risk of ACS in persons suffering from it, as compared to normotensive persons [12]. Studies show that persons suffering from diabetes mellitus who develop ACS, have poorer short-term as well as long-term outcomes, as compared to persons without this comorbidity [13]. Since an elevated lipid blood level is one of the most important factors in the process of atherosclerosis development, decreasing it would contribute to the decrease in morbidity and mortality from IHD, by as much as 40% [14].…”