The Impact of diabetes on long-term prognosis in non-ST elevation acute coronary syndrome

Abstract

Abstract
Background-In Algeria, there is a lack of up-to-date information regarding the burden of diabetes
in patients with coronary disease and its long-term prognostic impact. Our objective
was to evaluate the long-term prognostic impact of diabetes in the context of contemporary
management of patients with non-ST elevation acute coronary syndrome including a systematic
interventional approach.
Methods - A prospective study including all patients admitted to the cardiology department
of CHU Oran for non-ST elevation ACS from November 2015 to October 2016 and with a
five-year follow-up, a comparative study was carried out between the known diabetic group
and the non-diabetic group in terms of occurrence of major adverse cardiovascular and
cerebrovascular events.
Results -Of the 296 patients initially included, 274 completed the 5-year follow-up (7.4%
lost at follow-up). The diabetic group included 128 patients (46.7%) and is differentiated
from the non-diabetic group by the female predominance, more hypertension, dyslipidemia,
and obese and fewer smokers, more three-vessel disease, therapeutically more frequent
use of coronary artery bypass grafting. On the prognostic level, there is no significant
difference in cardiovascular mortality (19.5% vs. 12.3%; p=0.134). On the other hand, there
were more major adverse cardiovascular and cerebrovascular events in diabetics (43.0% vs
27.4%; p=0.008). In multivariate analysis, diabetes was an independent risk marker for the
occurrence of major adverse cardiovascular and cerebrovascular events at 5 years, and cardiovascular
mortality at 5 years, it is diabetes with more than 10 years old and not diabetes
in general which, is a prognostic marker.
Conclusion - With contemporary management of non-ST elevation ACS, the prognostic
weight of diabetes persists but tends to decrease.