Donahoe SM et al. (2007) Diabetes and mortality following acute coronary syndromes. JAMA 298: 765–775

Diabetes mellitus is a well-documented independent risk factor for the development of cardiovascular disease. The influence of diabetes on the outcomes of patients with acute coronary syndromes (ACS), however, is less clear. Using data pooled from 11 independent Thrombolysis in Myocardial Infarction Study Group trials, Donahoe and colleagues examined the effect of diabetes on mortality following ACS.

This study included 62,036 patients, 46,577 of whom had ST-segment elevation myocardial infarction (STEMI) and 15,459 of whom had non-STEMI. Diabetes mellitus was documented in 17.1% of the study cohort, and was significantly more prevalent among those with non-STEMI (P <0.001).

At 30 days after presentation with STEMI or non-STEMI, mortality was significantly higher in patients with diabetes than in patients without this condition (STEMI 8.5% vs 5.4%; non-STEMI 2.1% vs 1.1%; P <0.001 for both). When the data were adjusted for baseline characteristics, features of ACS presentation and ACS management, presence of diabetes was associated with a relatively higher incidence of death at 30 days in patients presenting with non-STEMI (odds ratio 1.78, 95% CI 1.24–2.56) than in patients presenting with STEMI (odds ratio 1.40, 95% CI 1.24–1.57). Mortality at 1 year after the ACS event was also higher in patients with diabetes than in those without, with diabetes conferring a 1.65-fold greater risk for all-cause mortality at 1 year in patients presenting with non-STEMI, and a 1.22-fold greater risk in patients presenting with STEMI.

Patients with ACS and comorbid diabetes, therefore, represent an extremely high-risk population that requires aggressive management.