[Early invasive strategy in diabetic patients with non-ST-segment elevation acute coronary syndromes]
Anna Baeza Román1, Jaime Latour Pérez1, Eva de Miguel Balsa1
1Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España.
Insights
Diabetic patients with non-ST-segment elevation acute coronary syndromes (NSTE-ACS) often receive conservative management. Predictors of conservative care include older age, comorbidities, bleeding risk, and specific electrocardiogram (ECG) findings.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Non-ST-segment elevation acute coronary syndromes (NSTE-ACS) management guidelines recommend invasive strategies for high-risk patients, including diabetics.
- Studies indicate paradoxical underutilization of invasive strategies in diabetic NSTE-ACS patients.
Purpose of the Study:
- To characterize diabetic patients with NSTE-ACS managed conservatively.
- To identify determinants influencing the choice between invasive and conservative strategies in this population.
Main Methods:
- Retrospective cohort study utilizing the ARIAM-SEMICYUC registry (2010-2011).
- Inclusion of 531 diabetic patients diagnosed with NSTE-ACS.
- Crude and adjusted unconditional logistic regression analyses were performed.
Main Results:
- Nearly half (49.7%) of diabetic NSTE-ACS patients underwent an invasive strategy.
- Conservative management was associated with older age, cardiovascular comorbidities, higher bleeding risk, and absence of high-risk ECG.
- Independent predictors for conservative strategy included low-risk ECG, Killip class >1, high bleeding risk, and clopidogrel pretreatment.
Conclusions:
- Underutilization of invasive strategies in diabetic NSTE-ACS patients may stem from concerns about bleeding complications.
- Fear of advanced coronary lesions might also contribute to the conservative approach in this patient group.
Background And Objectives:
In the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy.
Patients And Methods:
Retrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression.
Results:
We analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel.
Conclusions:
The fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS.
More Related Videos
10:28Interventional Diagnostic Procedure: A Practical Guide for the Assessment of Coronary Vascular Function
Published on: March 15, 2022
07:25Predicting Amputation using Local Circulating Mononuclear Progenitor Cells in Angioplasty-treated Patients with Critical Limb Ischemia
Published on: September 22, 2020
Related Concept Videos
01:28Acute Coronary Syndrome IV: Interprofessional Care
01:30Acute Coronary Syndrome I: Introduction
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:26Coronary Artery Disease IV: Preventive Measures
01:26Angina IV: Management
01:26Acute Coronary Syndrome V: Nursing Management