Fabin Natalia, Cenko Edina, Bergami Maria, Yoon Jinsung, Vadalà Giuseppe, Mendieta Guiomar, Kedev Sasko, Kostov Jorgo, Vavlukis Marija, Vraynko Elif, Miličić Davor, Vasiljevic Zorana, Zdravkovic Marija, Badimon Lina, Galassi Alfredo R, Manfrini Olivia, Bugiardini Raffaele
Laboratory of Epidemiological and Clinical Cardiology, Department of Medical and Surgical Sciences, University of Bologna, Policlinico Sant'Orsola Malpighi, Padiglione 11, Via Massarenti 9, 40138 Bologna, Italy.
Google Cloud Space, AI Department, Sunnyvale, CA, USA.
Cardiovasc Res. 2024 Dec 14;120(16):2064-2077. doi: 10.1093/cvr/cvae190.
To investigate the impact of an early coronary revascularization (<24 h) compared with initial conservative strategy on clinical outcomes in diabetic patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who are in stable condition at hospital admission.
The International Survey of Acute Coronary Syndromes database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Patients with cardiac arrest, haemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using logistic regression and inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) and odds ratios (ORs) with their 95% confidence intervals (CIs) were employed. Of the 7589 NSTE-ACS patients identified, 2343 were diabetics. The data show a notable reduction in mortality for the elderly (>65 years) undergoing early revascularization compared to those receiving an initial conservative strategy both in the diabetic (3.3% vs. 6.7%; RR: 0.48; 95% CI: 0.28-0.80) and nondiabetic patients (2.7% vs. 4.7%: RR: 0.57; 95% CI: 0.36-0.90). In multivariate analyses, diabetes was a strong independent predictor of mortality in the elderly (OR: 1.43; 95% CI: 1.03-1.99), but not in the younger patients (OR: 1.04; 95% CI: 0.53-2.06).
Early coronary revascularization does not lead to any survival advantage within 30 days from admission in young NSTE-ACS patients who present to hospital in stable conditions with and without diabetes. An early invasive management strategy may be best reserved for the elderly. Factors beyond revascularization are of considerable importance for outcome in elderly diabetic subjects with NSTE-ACS.
ClinicalTrials.gov: NCT01218776.
研究在入院时病情稳定的非ST段抬高型急性冠状动脉综合征（NSTE-ACS）糖尿病患者中，与初始保守策略相比，早期冠状动脉血运重建（<24小时）对临床结局的影响。
查询国际急性冠状动脉综合征数据库，选取诊断为NSTE-ACS的糖尿病和非糖尿病患者样本。排除心脏骤停、血流动力学不稳定和严重室性心律失常患者。使用逻辑回归和治疗权重逆概率模型对组间特征进行调整。主要结局指标为全因30天死亡率。采用风险比（RRs）和比值比（ORs）及其95%置信区间（CIs）。在7589例确诊的NSTE-ACS患者中，2343例为糖尿病患者。数据显示，与接受初始保守策略的患者相比，早期血运重建的老年（>65岁）糖尿病患者（3.3%对6.7%；RR：0.48；95%CI：0.28-0.80）和非糖尿病患者（2.7%对4.7%：RR：0.57；95%CI：0.36-0.90）死亡率显著降低。在多变量分析中，糖尿病是老年患者死亡率的强独立预测因素（OR：1.43；95%CI：1.03-1.99），但在年轻患者中并非如此（OR：1.04；95%CI：0.53-2.06）。
对于入院时病情稳定的年轻NSTE-ACS糖尿病和非糖尿病患者，早期冠状动脉血运重建在入院后30天内不会带来任何生存优势。早期侵入性管理策略可能最适合老年患者。对于老年NSTE-ACS糖尿病患者的结局，血运重建以外的因素相当重要。
ClinicalTrials.gov：NCT01218776。
