Influence du diabète sucré sur le pronostic des syndromes coronariens aigus sans sus décalage de ST

Abstract

Aim of study Analyze the influence of diabetes mellitus on the prognosis, at short and middle term of patients with non-ST-segment-elevation acute coronary syndrome. Patients and method We conducted a retrospective review of 308 consecutive medical records of patients admitted to the care unit of our department with a non-ST-segment-elevation acute coronary syndrome. One hundred and fifty-six patients were diabetics (group 1) and 152 were not (group 2). We compared the demographic, clinical, angiographic and therapeutic characteristics of the two groups and we analyzed the prognosis of diabetic and non-diabetic patients at short term (30 days) and at middle term (average: 28 months; extreme: 12 months, 72 months). Results The mean age was similar into both groups (60.8 years). Diabetic patients were more often women (42.1% vs 23.1%) and presented a higher prevalence of systemic hypertension, dyslipidemia and family history of coronary artery disease. Smoking was more frequent in group 2. The rates of coronary angiography, percutaneous transluminal coronary angioplasty, and coronary bypass surgery were similar in the two groups. At 30 days, diabetic patients were at increased risk for acute heart failure (19.1% vs 6.4%) and for major cardiac events (12.5% vs 6.4%). A pejorative prognosis was also observed at middle term among diabetic patients. They were at greater risk for readmissions for non-ST-segment-elevation acute coronary syndrome (42% vs 25%), for major cardiac events (49.3% vs 31.6%) and for new revascularizations (17.3% vs 7.2%). In a Cox multivariate analysis, diabetes mellitus remains an independent risk factor for major cardiac events at middle term. Conclusion Our study confirms the pejorative prognosis of acute coronary syndromes without ST elevation at short and middle term in diabetic patients.