An Invasive or Conservative Strategy in Patients With Diabetes Mellitus and Non–ST-Segment Elevation Acute Coronary Syndromes
Open accessAbstract
Objectives The purpose of this study was to conduct a meta-analysis to examine an invasive or conservative strategy in diabetic versus nondiabetic patients.Background Diabetic patients are at increased risk of cardiovascular events after an acute coronary syndrome, yet it remains unknown whether they derive enhanced benefit from an invasive strategy.Methods Randomized trials comparing an invasive versus conservative treatment strategy were identified. The prevalence of cardiovascular events through 12 months was reported for each trial, stratified by diabetes mellitus status and randomized treatment strategy. Relative risk (RR) ratios and absolute risk reductions were combined using random-effects models.Results Data were combined across 9 trials comprising 9,904 subjects of whom 1,789 (18.1%) had diabetes mellitus. The RRs for death, nonfatal myocardial infarction (MI), or rehospitalization with an acute coronary syndrome for an invasive versus conservative strategy were similar between diabetic patients (RR: 0.87; 95% confidence interval [CI]: 0.73 to 1.03) and nondiabetic patients (RR: 0.86; 95% CI: 0.70 to 1.06; p interaction = 0.83). An invasive strategy reduced nonfatal MI in diabetic patients (RR: 0.71; 95% CI: 0.55 to 0.92), but not in nondiabetic patients (RR: 0.98; 95% CI: 0.74 to 1.29; p interaction = 0.09). The absolute risk reduction in MI with an invasive strategy was greater in diabetic than nondiabetic patients (absolute risk reduction: 3.7% vs. 0.1%; p interaction = 0.02). There were no differences in death or stroke between groups (p interactions 0.68 and 0.20, respectively).Conclusions An early invasive strategy yielded similar RR reductions in overall cardiovascular events in diabetic and nondiabetic patients. However, an invasive strategy appeared to reduce recurrent nonfatal MI to a greater extent in diabetic patients. These data support the updated guidelines that recommend an invasive strategy for patients with diabetes mellitus and non-ST-segment elevation acute coronary syndromes.
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Mortality correlates more strongly to the blood glucose level than to the presence of diabetes.
“Mortality correlates more strongly to the blood glucose level than to the presence of diabetes.419,420”
From 2023 ESC guidelines for the management of cardiovascular disease in patients with diabetes. (2023) · cites this paper as [419]
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- Authors
- O'Donoghue, M. L., Vaidya, A., Afsal, R., Alfredsson, J., Boden, W. E., Braunwald, E., Cannon, C. P., Clayton, T. C., de Winter, R. J., Fox, K. A. A., Lagerqvist, B., McCullough, P. A., Murphy, S. A., Spacek, R., Swahn, E., Windhausen, F., & Sabatine, M. S.
- Affiliations
- University of California, San Francisco (US)
- Hamilton Health Sciences (CA)
- Linköping University (SE)
- Albany Stratton VA Medical Center Albany (US)
- Brigham and Women's Hospital (US)
- London School of Hygiene & Tropical Medicine (GB)
- Edinburgh Royal Infirmary (GB)
- Uppsala University Hospital (SE)
- Ascension (US)
- Charles University (CZ)
- Amsterdam UMC Location University of Amsterdam (NL)
- ORCID
- Venue
- Journal of the American College of Cardiology
- Publisher
- Elsevier BV
- Published
- 2012-07
- Volume
- 60
- Issue
- 2
- Pages
- 106-111
- ISSN
- 0735-1097 (ISSN-L)
- OpenAlex
- W1953901651
- Cited by
- 106
- References
- 13
- Citations by year
- 2026: 2 · 2025: 1 · 2024: 3 · 2023: 7 · 2022: 8 · 2021: 4 · 2020: 9 · 2019: 8 · 2018: 5 · 2017: 10 · 2016: 8 · 2015: 14 · 2014: 14 · 2013: 12 · 2012: 1
- FWCI
- 13.35
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Journal of the American College of Cardiology (publishedVersion)
- PubMed (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Pure Amsterdam UMC (submittedVersion)
- Funders
- The Medicines Company
- Merck
- AstraZeneca
- Johnson & Johnson
- Beckman Coulter
- Eli Lilly
- Roche Diagnostics
- sanofi-aventis
- Daiichi Sankyo
- GlaxoSmithKline
- Bristol-Myers Squibb
- Pfizer
- Abbott
- Roche
- Takeda
- Nanosphere
- Bristol-Myers Squibb/sanofi-aventis
- Accumetrics
- Merck & Co.
- Topics
- Health Sciences › Medicine › Surgery › Coronary Interventions and Diagnostics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Acute Myocardial Infarction Research
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Antiplatelet Therapy and Cardiovascular Diseases
- Keywords
- diabetes mellitus, non-ST-elevation acute coronary syndrome, invasive strategy, conservative strategy, myocardial infarction, cardiovascular events, hospital readmission, mortality, stroke, guideline recommendations
- MeSH terms
- Diabetic Angiopathies, Hospitalization, Humans, Myocardial Infarction, Recurrence, Randomized Controlled Trials as Topic, Treatment Outcome, Practice Guidelines as Topic, Risk Assessment, Acute Coronary Syndrome
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