Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology.

Abstract

Diabetes mellitus (diabetes) is common amongst patients with NSTEMI. We describe presentation, care and outcomes of patients admitted with NSTEMI by diabetes status. Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type≥3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2%vs 3.7%, P<0.001), haemodynamic instability (7.1%vs 3.7%, P<0.001) and ongoing chest pain (43.1%vs 37.0%, P<0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0%vs 60.5% received≥80% of eligible care interventions, P=0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3%vs 6.8% P<0.001), cardiogenic shock (4.5%vs 2.5%, P=0.002), stroke/TIA (2.0%vs 0.8%, P=0.006) and death (2.5%vs 1.4%, P=0.022), and higher 30-day mortality (3.3%vs 2.0%, P=0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for GLP-1 RAs and SGLT2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation. NSTEMI patients with diabetes, compared to those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.