Abstract 18529: Early Coronary Revascularization Among "Stable" Patients With Non-ST-Segment Elevation Acute Coronary Syndromes: The Role of Diabetes and Age

Abstract

Introduction: Despite improvement in the management of patients with non-ST-elevation acute coronary (NSTE-ACS), this condition is still linked to a substantially increased mortality and morbidity among diabetic patients. Specifically, it remains uncertain whether patients whose condition can safely be stabilized at hospital admission should routinely receive an early coronary revascularisation. Hypothesis: We tested the hypothesis that a strategy of early coronary revascularization within 24 hours of diagnosis is superior to an initial conservative strategy in terms of clinical outcomes in diabetic patients who met stabilisation criteria at hospital admission. Comparison was made with a cohort of nondiabetic patients. Methods: The ISACS-TC database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Those with recurrent angina after hospital admission, cardiac arrest, haemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using inverse probability of treatment weighting models. Co-primary end points were all cause 30-day mortality and the composite end point of all cause 30-day mortality and left ventricular (LV) systolic dysfunction. Risk ratios (RRs) with their 95% CIs were employed. Results: Of the 7,473 NSTE-ACS patients identified, 2,220 were diabetics. Early revascularization was associated with survival benefit only in the elderly (≥65 years) both in diabetics (3.7% vs 6.6%; RR: 0.56; 95% CI: 0.32-0.96) and nondiabetic patients (2.8% vs 5.1%: RR: 0.55; 95% CI: 0.34-0.87). In the elderly population, an initial conservative strategy increased the risk of death or LV systolic dysfunction by 15.2% in diabetics compared with nondiabetic patients (37.7% vs 32.7%; RR: 1.15; 95% CI: 1.02-1.30). Conclusions: Early coronary revascularization does not lead to any survival advantage within 30 days from admission in a large number of NSTE-ACS patients who present to hospital in stable conditions. An early invasive management strategy may be best reserved for the elderly either with or without diabetes. The benefit of this strategy appears to be more pronounced in the diabetic population.