Mahmoud Ahmed N, Elgendy Islam Y, Mansoor Hend, Wen Xuerong, Mojadidi Mohammad K, Bavry Anthony A, Anderson R David
Division of Cardiovascular Medicine, Department of Medicine, University of Florida, Gainesville, FL.
Department of Pharmaceutical Outcomes and Policy, University of Florida, Gainesville, FL.
J Am Heart Assoc. 2017 Mar 18;6(3):e005369. doi: 10.1161/JAHA.116.005369.
There are limited data on the merits of an early invasive strategy in diabetics with non-ST-elevation acute coronary syndrome, with unclear influence of this strategy on survival. The aim of this study was to evaluate the in-hospital survival of diabetics with non-ST-elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy.
The National Inpatient Sample database, years 2012-2013, was queried for diabetics with a primary diagnosis of non-ST-elevation acute coronary syndrome defined as either non-ST-elevation myocardial infarction or unstable angina (unstable angina). An early invasive strategy was defined as coronary angiography±revascularization within 48 hours of admission. Propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. Incidence of in-hospital mortality was compared in both groups. In a cohort of 363 500 diabetics with non-ST-elevation acute coronary syndrome, 164 740 (45.3%) were treated with an early invasive strategy. Propensity scoring matched 21 681 diabetics in both arms. Incidence of in-hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [OR], 0.41; 95% CI, 0.39-0.42; <0.0001) and propensity-matched models (2.2% vs 3.8%; OR, 0.57; 95% CI, 0.50-0.63; <0.0001). The benefit was observed across various subgroups, except for patients with unstable angina (=0.02).
An early invasive strategy may be associated with a lower incidence of in-hospital mortality in patients with diabetes. The benefit of this strategy appears to be superior in patients presenting with non-ST-elevation myocardial infarction compared with unstable angina.
关于非ST段抬高型急性冠状动脉综合征糖尿病患者早期侵入性策略的益处的数据有限，且该策略对生存率的影响尚不清楚。本研究的目的是评估采用早期侵入性策略与初始保守策略治疗的非ST段抬高型急性冠状动脉综合征糖尿病患者的院内生存率。
查询2012 - 2013年国家住院患者样本数据库，筛选出原发性诊断为非ST段抬高型急性冠状动脉综合征（定义为非ST段抬高型心肌梗死或不稳定型心绞痛）的糖尿病患者。早期侵入性策略定义为入院48小时内进行冠状动脉造影±血运重建。倾向评分用于组建一个队列，该队列采用早期侵入性或初始保守策略进行管理，在50多个基线特征和医院表现方面达到平衡。比较两组的院内死亡率。在363500例非ST段抬高型急性冠状动脉综合征糖尿病患者队列中，164740例（45.3%）接受了早期侵入性策略治疗。倾向评分匹配两组各21681例糖尿病患者。在未调整模型（2.0%对4.8%；比值比[OR]，0.41；95%可信区间[CI]，0.39 - 0.42；<0.0001）和倾向评分匹配模型（2.2%对3.8%；OR，0.57；95%CI，0.50 - 0.63；<0.0001）中，早期侵入性策略的院内死亡率均较低。除不稳定型心绞痛患者外（P = 0.02），在各个亚组中均观察到了这一益处。
早期侵入性策略可能与糖尿病患者较低的院内死亡率相关。与不稳定型心绞痛患者相比，该策略在非ST段抬高型心肌梗死患者中似乎益处更大。
