Acute Coronary Syndrome In Diabetic Patients Research Articles

Safety and efficacy of bivalirudin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI)

Abstract Background Prevention of hemorrhagic complications has emerged as a priority in patients undergoing Percutaneous Coronary Intervention (PCI) in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic Acute Coronary Syndrome (ACS) patients as Diabetes Mellitus (DM) itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI by American College of Cardiology (ACC 2013). Whether Bivalirudin is safe and effective specially in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown. Purpose To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic ACS patients undergoing PCI. Methods 218 diabetic ACS patients (age>18 years and ≤75 years) who underwent PCI from May 2018 to April 2019 at University Cardiac Centre, BSM Medical University, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70–100 U/kg (targeted activated clotting time, ACT: 200–250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke]. Results Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between two groups (p>0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). Conclusion In diabetic ACS patients undergoing PCI, Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin. Funding Acknowledgement Type of funding sources: None.

Safety and Efficacy of Bivalirudin in Diabetic Acute Coronary Syndrome (ACS) Patients Undergoing Percutaneous Coronary Intervention (PCI)

Objective: To determine and compare the incidence of in-hospital and 30-day hemorrhagic complications and major adverse cardiac events (MACEs) as evidence of safety and efficacy using Bivalirudin versus Heparin in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI) in a tertiary care cardiac hospital.
 Background: Prevention of hemorrhagic complications has emerged as a priority in patients undergoing PCI in addition to suppressing thrombotic complications. This goal is challenging to achieve in diabetic ACS patients as DM itself is a prothrombotic state with more pronounced vascular injury response and have a worse outcome after PCI compared with non-diabetic patients. In patients with ACS, Bivalirudin has been shown to result in similar rates of composite ischemia as Heparin plus GPI (GP IIb /IIIa inhibitor), while significantly reducing major bleeding and has received class I recommendation for PCI. Whether Bivalirudin is safe and effective in diabetic ACS patients undergoing PCI, as compared with Heparin (UFH) monotherapy, is unknown.
 Methods: 218 diabetic ACS patients (age>18 years and ≤ 75 years) who underwent PCI from May 2018 to April 2019 at UCC, BSMMU, Dhaka, Bangladesh were randomly assigned to have UFH or Bivalirudin. Before the guide wire crossed the lesion, 111 patients in the UFH group received a bolus of 70-100 U/kg (targeted activated clotting time, ACT: 200-250 s). 107 patients in the Bivalirudin group received a loading dose of 0.75 mg/kg, followed by an infusion of 1.75 mg/kg/h for up to 4 hours. Dual antiplatelet (DAPT) loading as Aspirin 300 mg plus P2Y12 inhibitors (Clopidogrel 600 mg or Prasugrel 60 mg or Ticagrelor 180 mg) was given in all patients before the procedure. The maintenance dose of DAPT was continued for at least one month and patients were followed telephonically up to 30 days. The outcome measures were in-hospital and 30-day hemorrhagic complications and MACEs [death, MI, target vessel revascularization (TVR) and stroke].
 Results: Patients treated with Bivalirudin compared with Heparin had a significantly lower in-hospital incidence of QMI (0% vs. 6%; p=0.03) and major bleeding (0% vs. 7%; p=0.02). However, the incidence of cardiac death, stent thrombosis, TVR were no differences between the groups (p>0.05). There was only one NQMI in the Bivalirudin group as opposed to 8% in the Heparin group in 30 days following stenting (p=0.04). No other adverse effects were found significantly different between groups in 30 days of PCI.
 Conclusion: In this small scale, prospective, randomized controlled study of diabetic ACS patients undergoing PCI in a single center showed that Bivalirudin is safe and effective as it reduces immediate and short-term hemorrhagic complications as well as MACEs as compared with Heparin.

Diagnostic accuracy of left ventricular diastolic transverse strain imaging by speckle tracking echocardiography for diagnosing chest pain in diabetic patients

Abstract Background Two-dimensional speckle tracking echocardiography (2D-STE) has been reported to be useful for the diagnosis of myocardial ischemia by detecting delayed relaxation (diastolic stunning) after an episode of angina. 2D-longitudinal strain is not specific besides ischemia such as diastolic dysfunction, and diabetes have been associated with abnormal longitudinal fibers. The aim is to evaluate the diagnostic accuracy of Left ventricular (LV) diastolic transverse strain imaging by STE to detect the presence of acute coronary syndrome (ACS) in diabetic patients with acute chest pain. Methods 385 consecutive patients with acute chest pain and without wall motion abnormality, who were admitted to an emergency department (ED) at 1 of 12 clinical sites in Japan, were enrolled and underwent 2D-STE at ED. Left ventricular (LV) transverse strain values at aortic valve closure (A) and one-third of diastole duration (B) were measured. The strain imaging diastolic index (SI-DI) was value was determined as: (A − B)/A × 100% to assess the LV diastolic strain imaging and was used to identify the regional LV delayed relaxation. All patients underwent coronary CT or coronary angiography to establish the diagnosis of ACS. Clinicians were blinded to the 2D-STE results. Results Out of 385 patients, 2D-STE analysis was possible in 365 patients (94%). 76 patients were diabetic (DM+), and 289 patients were non-diabetic (DM-). With assessment of coronary CT or coronary angiography, ACS was diagnosed in 125 patients (34%). 2D-STE was obtained at a mean of 5.3 hours after chest pain episode. Transverse SI-DI of ischemic segments were significantly lower than those of non-ischemic segments (p value <0.001) in both diabetic and non-diabetic patients, and transverse SI-DI of both diabetic and non-diabetic patients demonstrated high area under curve (AUC) for detection of myocardial ischemia (Figure: RCA; right coronary artery, LAD; left anterior descending artery, LCX; left circumferencial artery). In diabetic patients, sensitivity, specificity, and negative predictive value for ACS of transverse SI-DI are 100%, 95%, 100% in RCA (a cut-off value of 36.2), and 86.4%, 95%, 93% in LAD (a cut-off value of 50.2), and 75%, 85%, 94% in LCX (a cut-off value of 52), respectively. Conclusion LV diastolic transverse strain imaging by 2D-STE at ED increase the sensitivity, specificity and accuracy to predict the presence of ACS in diabetic patients with chest pain, as well as non-diabetic patients. (UMIN000013859). Figure 1. Transverse Strain (SI-DI): AUC (95% CI) Funding Acknowledgement Type of funding source: None

Vildagliptin vs. insulin treatment alone in diabetic acute coronary syndrome patients.

Vildagliptin, an oral antidiabetic of the dipeptidyl peptidase-4 (DPP-4) inhibitor drugs, exhibits an overall low risk of hypoglycemia with less frequent hypoglycemic events in type 2 diabetes mellitus (T2DM) patients than other antidiabetic drugs. We hypothesized that among hospitalized acute coronary syndrome (ACS) patients, the addition of vildagliptin to subcutaneous insulin therapy would reduce the risk of hypoglycemic events. One hundred ACS T2DM adult patients naive to DPP-4 inhibitors were enrolled during admission to the ICCU. Patients were divided into two randomized controlled groups: a subcutaneous rapid-acting insulin-only therapy group and an oral vildagliptin plus subcutaneous insulin group. The trial was open label with no placebo arm. Mean glucose values, insulin values given for correction per hospitalization, and the number of hypoglycemic events (glucose < 70 mg/dL) were documented. Eight hypoglycemia events occurred in the insulin-only group and none in the insulin plus DPP-4 inhibitor group (P < 0.001). Patients with acute myocardial infarction experienced a higher number of hypoglycemic events compared with unstable angina diagnosed patients. No significant differences were found regarding glucose level (P = 0.462) and administered insulin units (P = 0.639). In T2DM patients, the addition of DPP-4 inhibitors to routine subcutaneous insulin therapy may significantly reduce hypoglycemic events while maintaining acceptable recommended ranges of glucose. Further studies on a larger scale are required to verify these results and to support that DPP-4 inhibitors added to today's standard insulin-only treatment in hospitalized diabetic ACS patients may improve overall glycemic control and provide a potential treatment option in this challenging clinical setting.

P6420Can machine learning help us improve risk stratification of diabetic patients with acute coronary syndromes? The answer will blow your mind

Abstract Background Risk stratification following an acute coronary syndrome (ACS) is of utmost importance, in order to identify patients at higher risk of subsequent cardiovascular events. Diabetic patients have a significantly worse prognosis, so new risk prediction tools are important to better identify and risk stratify high risk patients within this important ACS subpopulation. Aim The aim of this study was to identify the best predictors of a new ACS, in a single-center database of ACS, resorting to machine learning and artificial intelligence, and to compare the Global Registry of Acute Coronary Events (GRACE) risk score's relevance for risk discrimination in a general ACS population versus a subpopulation of diabetic patients. Methods In a single center, 5977 patients admitted due to ACS between 2004 and 2017 and alive at discharge were studied. In the subpopulation of diabetic patients (n=3429), each covariate present in the database was analyzed separately with a Cox proportional hazard model with three terms – subpopulation belonging indicator, covariate, interaction term. The p-value of the interaction term was used to rank variables. The more significant the interaction term, the stronger the change in relationship between patients in the subpopulation and the risk of a new ACS, compared to the one in the general population. Results During long term follow-up, 13% of patients (n=771) experienced a second event. Kaplan-Meier curve represents how ACS free-survival depends on the GRACE risk score and group of interest. In the general population and in the subpopulation of diabetic patients, the GRACE score was used to further divide patients into 3 terciles, of which only the lower and upper tercile are shown (GRACE ≤113 and GRACE &gt;144, respectively). The solid lines represent Kaplan-Meier curves for diabetic patients, and the dotted lines in the general population. Pink or grey colour of the curves represent the stratification level of the covariate. Conclusions In our model, the GRACE risk score was found to be a better discriminator of risk of futher ACS in diabetic patients than in the general ACS population. Strikingly, a higher GRACE score predicts a lower rate of readmission, probably because many patients will die in the index hospitalization or out of hospital. This finding reinforces the usefulness of the GRACE score in high risk patients and may improve risk stratisfication in diabetic post-ACS patients, making sure that they are closely followed and submitted to optimal risk factor management, in order to improve their post-ACS prognosis.

Association of Isoprostanes-Related Oxidative Stress with Vulnerability of Culprit Lesions in Diabetic Patients with Acute Coronary Syndrome.

Urinary excretion of 8-iso-prostaglandin F2α (8-iso-PGF2α), a reliable biomarker for enhanced oxidant stress in vivo, has been described in association with diabetes and coronary heart disease. The aim of this study was to evaluate the relationship between urinary 8-iso-PGF2α levels and the characteristics of coronary culprit lesion in diabetic patients with acute coronary syndrome (ACS). A total of 79 diabetic patients with ACS were included. iMAP intravascular ultrasound (iMAP-IVUS) was performed to evaluate the characteristics of culprit plaques. Fasting urinary 8-iso-PGF2α level was measured and corrected by creatinine clearance. iMAP-IVUS data showed culprit plaques in high urinary 8-iso-PGF2α level patients had a greater percentage of necrotic core and less fibrous components. High urinary 8-iso-PGF2α levels were correlated with increased necrotic plaque components (r = 0.325, P = 0.003). Meanwhile, the presence of thin-capped fibroatheroma (50.0% versus 11.5%, P = 0.003), ruptured plaques (30.8% versus 7.7%, P = 0.035), and thrombus (38.5% versus 7.7%, P = 0.008) were significantly more frequent in the upper tertile of urinary 8-iso-PGF2α levels than in the low tertile. Multivariate analysis showed high levels of urinary 8-iso-PGF2α (OR 4.240, P = 0.007) was independently associated with the presence of vulnerable culprit plaque in diabetic ACS patients. Urinary 8-iso-PGF2α also displayed a significant value in predicting vulnerable plaques in diabetic patients with ACS by constructing the receiver-operating characteristic (ROC) curve (Area under the ROC curve: 0.713, P = 0.001). Urinary 8-iso-PGF2α levels are associated with the vulnerability of the coronary culprit lesion in diabetic patients with ACS and may provide additional information for risk assessment in suspected vulnerable patients.

Comparative Outcome of Acute Coronary Syndrome In Diabetics and Non-diabetics

Background : It is well known that Coronary Artery Disease (CAD) is strongly associated with Diabetes Mellitus (DM). When CAD develops in diabetic patients the incidence of Acute Coronary Syndrome (ACS) becomes double. Diabetics also suffer more heart failure, pulmonary edema &amp; renal failure while in hospital. The proportion of ACS in diabetic patients is increasing. This trend will likely continue because the population has become more sedentary and overweight. A few studies available comparing the various outcomes of ACS patients with &amp; without DM in our country yet we know that burden of both ACS and DM in our population is increasing. Materials and methods: This analytical study was conducted from July, 2013 to June, 2104 in the Department of Cardiology of Chittagong Medical College Hospital. Subjects were by purposive sampling and grouped into two groups as diabetic (Group A) &amp; non diabetic (Group B) each group had 100 patients. Data processing and analysis was done with the help of computer using statistical software SPSS version-17 for windows. Statistical analyses were done by appropriate tests of significances (i.e. t-test, chi-square test). Results: The diabetic group had a significantly higher mean age (52.84 ±8.40 years) compared to the non-diabetic group (47.96 ± 9.52) (p=0.000) and majorities of the patients were male. Raised level of Serum Troponin I and mean LVEF was highly significant between the groups. The patients of both groups developed cardiogenic shock and heart failure in a different proportion (10 % and 4%: p= 0.042) which was statistically significant. Arrhythmia was an outcome in both groups without significant difference and recurrent angina was only found in diabetic group (n=06). Conclusion: Our study revealed higher number of complications, mortality and worse clinical features in diabetic ACS patients determining the additional adversities and complicated management with a lower prognostic outcome.&#x0D; JCMCTA 2018 ; 29 (1) : 28-34

Prognostic role of soluble ST2 in acute coronary syndrome with diabetes.

Acute coronary syndrome (ACS) patients are at an increased risk of major adverse cardiovascular events (MACE). The objective of our study was to assess whether cardiac biomarker like soluble ST2 (sST2) can predict MACE among ACS patients with diabetes. A total of 122 patients with ACS were included in the study. sST2 level in blood plasma samples was quantified using enzyme-linked immunosorbent assay (ELISA). Prognostic utility of sST2 for the primary outcome of MACE which included mortality, rehospitalization due to chest pain, unstable angina, recurrent myocardial infarction (MI) and stroke, was assessed during follow-up. The median follow-up period was of 180days. ROC (receiver operating characteristic) curve demonstrated that elevated levels of sST2 were able to predict mortality, and MACE in ACS patients, along with increased risk of occurrence of MACE and mortality in ACS patients having diabetes. Kaplan-Meier plots revealed a significant increase in the occurrence of MACE in diabetic ACS patients (P=0.006; by log-rank test). Cox regression analysis revealed that sST2 is not an independent predictor of mortality and MACE in ACS patients having diabetes; however, high sST2 level was found to be a predictor of MACE in all ACS subjects in the fully adjusted model with a hazard ratio (HR) of 5.8 (P=0.032). The current study indicates that elevated levels of sST2 might be a suitable biomarker to evaluate the risk of future adverse cardiovascular events in ACS patients with diabetes.

Role of Diabetic Dyslipidemia on Coronary Atherosclerotic Severity in Acute Coronary Syndrome

Aims: To evaluate the association of coronary atherosclerotic severity in diabetic dyslipidemic patients of acute coronary syndrome.Methods: This was a cross sectional comparative analytical study, done in the Department of Cardiology, Sir Salimullah Medical College Mitford Hospital and Ibrahim Cardiac Hospital &amp; Research Institute, Dhaka, during September 2009 to August 2010.Results: Most of the patients (57.5%) were in the age range of 40-70 years. Atherosclerotic severity in diabetic ACS patients was significantly higher with low HDL, high TC/HDL and high LDL/HDL ratio. Low HDL, high TC/HDL and high LDL/HDL ratio are indicators of the extent and severity of coronary artery disease. More frequent dyslipidemia in diabetic ACS patients were low HDL and it was about 54%.Conclusion: Atherosclerotic severity in diabetic acute coronary syndrome patients was significantly more in dyslipidemic group than non dyslipidemic group.Bangladesh Heart Journal 2016; 31(2) : 65-69

Abstract 133: Comparative Effectiveness and Clinical Outcomes of Clopidogrel versus Prasugrel in Acute Coronary Syndrome Patients with Diabetes Mellitus Undergoing Percutaneous Coronary Intervention

Background: Compared to the common antiplatelet clopidogrel, randomized trials have shownthe novel antiplatelet prasugrel reduces ischemic events without increasing major bleeding in diabetic acute coronary syndrome (ACS) patients undergoing percutaneous coronary intervention (PCI). However, the clinical and cost implications of clopidogrel versus prasugrel in diabetic ACS patients are limited in real-world settings. Methods: Using a shared electronic medical record we reviewed all primary PCI cases at three high volume centers from July 1, 2009 to December 31, 2013. Any complication, red blood cell transfusions, bleeding &lt;72 hours, peri-procedural myocardial infarction, cerebrovascular accident, mortality, length of stay (LOS) and total variable costs were compared between diabetic ACS patients receiving clopidogrel or prasugrel. All patients ≥75 years, &lt;60 kilograms, or with history of cerebrovascular disease were excluded to account for contraindications and bleeding risk factors associated with prasugrel use. Results: Among 2,165 PCI cases, 1,899 (87.7%) received clopidogrel and 266 (12.3%) received prasugrel. The only difference in baseline demographic and clinical characteristics was older age in patients who received clopidogrel (62 years vs. 60 years; p&lt;0.001). No significant differences in any complication, red blood cell transfusions, bleeding &lt;72 hours, peri-procedural myocardial infarction, cerebrovascular accident or mortality were observed between treatment groups. Total variable costs were $1,271 higher in patients who received prasugrel (p&lt;0.001) and LOS was 0.2 days longer (p=0.011) (Table). Conclusions: In diabetic ACS patients undergoing PCI in a real-world clinical setting, there was no significant difference in peri-procedural complications with prasugrel versus clopidogrel antiplatelet therapy. Prasugrel was associated with higher costs and longer LOS.

Comparitive angiographic profile in diabetic and non-diabetic patients with acute coronary syndrome.

Cardiac adversity is by far the commonest cause of mortality in patients with diabetes. Cardiac involvement in diabetes commonly manifest as coronary artery disease (CAD). Definitive diagnosis,precise assessment and anatomic severity of CAD requires invasive diagnostic modality like coronary angiography. To study angiographic extents, type of vessels, number of vessels, severity involving coronary artery and its branches in patients with acute coronary syndrome(ACS).Compare the same in diabetics and non diabetics with ACS. Hundred patients with ACS,50 diabetics and 50 nondiabetics admitted in Bapuji Hospital ICCU attached to J.J.M. Medical College were selected randomly during a period of approximately one and half years formed the study group. RBS, FBS was done in all 100 pateints, HbA1c in all diabetics. All subjects with ACS were taken up for coronary angiography. Chi-square test was used to determine any significant difference between two groups. p-value of less than 0.05 was considered significant. In our study 22 (44%) out of 50 diabetic patients had triple or multi-vessel disease compared to 8 (16%) out of 50 non diabetics. Hundred patients with ACS, number of vessels involved were 199, of which 61.3% in diabetics and 38.6% in non diabetics, 23(46%) of 50 diabetic patients required CABG as treatment outcome. HbA1c levels of >8.5%, 69.2% had triple / multi vessel disease and 19 (73.1%) of 23 patients who had to undergo CABG had HbA1c levels >8.5%, 24% of diabetics were in third decade, 40% were in fourth decade as compared to 10% and 26% of non-diabetics of similar age group. This study showed that ACS in diabetic patients presented much earlier in life, the severity and extent of CAD and incidence of triple/multi vessel disease was significantly high in diabetics when compared to nondiabetics with ACS. Diabetics with high HbA1c had more number of coronary vessel involvement and the mode of treatment required in them was CABG.

Abstract 48: Diabetic Patients with Acute Coronary Syndrome Have Better 6 Month and 2 Year Outcomes with Revascularization Compared to Medical Therapy Alone

Background: Recent trials suggest patients with diabetes may do better with coronary-artery bypass graft (CABG); however long-term trends in the rates of CABG and percutaneous coronary intervention (PCI) compared to medical therapy from a real-world population are not well known. Methods: We analyzed 1003 DM patients admitted with acute coronary syndrome (ACS) from 1999 to 2008 at a tertiary care center. Rates of revascularization were examined by study year. In addition in-hospital, 6mo and 2yr outcomes were obtained by phone interview and medical chart review. Multiple logistic regression models were created for 6mo and 2yr outcomes, adjusting for variables known to be associated with mortality. Results: Of 1003 DM/ACS patients, 505 were medically managed, 399 received percutaneous coronary intervention (PCI) and 99 received a coronary-artery bypass graft (CABG). At baseline, the medical group was the oldest and sickest. Rates of CABG increased particularly in the years between 2001 and 2003, and rates of PCI increased from 2003 to 2006. Both types of revascularization procedures have declined in recent years and medical management accounts for over 50% of diabetic ACS patients. (Figure 1) At 6mo, both CABG (p=0.02, OR 0.17, 95%CI 0.04-0.74) and PCI (p=0.03, OR 0.46, 95%CI 0.23-0.92) reduced mortality among DM patients after controlling for the GRACE risk score. A similar reduction in mortality was noted at 2yr for CABG (p=0.01, OR 0.35, 95%CI 0.16-0.77) and PCI (p=0.03, OR 0.62, 95%CI 0.40-0.95) compared to medical therapy alone. Conclusions: Rates of revascularization among DM/ACS patients have declined in recent years, particularly for CABG. Both types of revascularization are associated with significant survival benefit, suggesting improving access to these procedures among DM/ACS patients is warranted.

PCV9 Optimal Treatment Shortfalls and Worse 12-Month Outcomes for Diabetic Acute Coronary Syndrome Patients After Percutaneous Coronary Intervention in Contemporary Practice: Data from the Multinational, Prospective, Antiplatelet Treatment Outcomes Registry (APTOR)

PCV9 Optimal Treatment Shortfalls and Worse 12-Month Outcomes for Diabetic Acute Coronary Syndrome Patients After Percutaneous Coronary Intervention in Contemporary Practice: Data from the Multinational, Prospective, Antiplatelet Treatment Outcomes Registry (APTOR)

Relationship between admitting nonfasting blood glucose and in-hospital mortality stratified by diabetes mellitus among acute coronary syndrome patients in Oman

Background and Objectives:Hyperglycemia in patients admitted for acute coronary syndrome (ACS) is associated with increased in-hospital mortality. We evaluated the relationship between admitting (nonfasting) blood glucose and in-hospital mortality in patients with and without diabetes mellitus (DM) presenting with ACS in Oman.Patients and Methods:Data were analyzed from 1551 consecutive patients admitted to 15 hospitals throughout Oman, with the final diagnosis of ACS during May 8, 2006 to June 6, 2006 and January 29, 2007 to June 29, 2007, as part of Gulf Registry of Acute Coronary Events. Admitting blood glucose was divided into four groups, namely, euglycemia (≤7 mmol/l), mild hyperglycemia (>7-<9 mmol/l), moderate hyperglycemia (≥9-<11 - mmol/l), and severe hyperglycemia (≥11 mmol/l).Results:Of all, 38% (n = 584) and 62% (n = 967) of the patients were documented with and without a history of DM, respectively. Nondiabetic patients with severe hyperglycemia were associated with significantly higher in-hospital mortality compared with those with euglycemia (13.1 vs 1.52%; P<0.001), mild hyperglycemia (13.1 vs 3.62%; P = 0.003), and even moderate hyperglycemia (13.1 vs 4.17%; P = 0.034). Even after multivariate adjustment, severe hyperglycemia was still associated with higher in-hospital mortality when compared with both euglycemia (odds ratio [OR], 6.3; P<0.001) and mild hyperglycemia (OR, 3.43; P = 0.011). No significant relationship was noted between admitting blood glucose and in-hospital mortality among diabetic ACS patients even after multivariable adjustment (all P values >0.05).Conclusion:Admission hyperglycemia is common in ACS patients from Oman and is associated with higher in-hospital mortality among those patients with previously unreported DM.

TCT-311: High-density Lipoprotein Cholesterol Level may Predicts 1-year Clinical Outcomes in Diabetic Acute Coronary Syndrome Patients treated with Drug-eluting Stents

TCT-311: High-density Lipoprotein Cholesterol Level may Predicts 1-year Clinical Outcomes in Diabetic Acute Coronary Syndrome Patients treated with Drug-eluting Stents

Plaque Characteristics in Culprit Lesions and Inflammatory Status in Diabetic Acute Coronary Syndrome Patients

The aim of this study was to assess the plaque characteristics in culprit lesions in diabetic patients with acute coronary syndrome (ACS). Data of the relationship between diabetes mellitus and plaque characteristics in patients with ACS are lacking. We performed grayscale intravascular ultrasound (IVUS) analysis in 422 ACS patients and virtual histology (VH)-IVUS in 310 ACS patients. By subgroup analysis, 112 patients with acute myocardial infarction (AMI) with plaque ruptures also were evaluated. In the diabetic subgroup, high-sensitivity C-reactive protein (hs-CRP) was significantly increased (p = 0.008), multivessel disease was more common (65% vs. 29%, p < 0.001), and plaque burden was greater (79.7 +/- 9.8 mm2 vs. 74.2 +/- 8.9 mm2, p < 0.001). In the subgroup analysis of 112 AMI patients with plaque ruptures, the presence of multiple plaque ruptures (60% vs. 29%, p = 0.001) and thrombus (72% vs. 52%, p = 0.032) were more common in diabetic group. Diabetes mellitus was the independent predictor of hs-CRP elevation (odds ratio [OR]: 3.030, 95% confidence interval [CI]: 1.204 to 7.623, p = 0.019), and multiple plaque ruptures (OR: 2.984, 95% CI: 1.311 to 6.792, p = 0.009) by multivariable analysis. In 310 VH-IVUS subsets, the absolute and percent necrotic core volumes were significantly greater (16.9 +/- 15.1 mm3 vs. 11.5 +/- 11.4 mm3, p < 0.001, and 17.3 +/- 9.4% vs. 13.7 +/- 7.5%, p < 0.001, respectively), and the presence of at least one thin-cap fibroatheroma (TCFA) (60% vs. 42%, p = 0.003) and multiple TCFAs (28% vs. 11%, p < 0.001) were more common in the diabetic group. Diabetes mellitus was the only independent predictor of TCFA by multivariable analysis (OR: 2.139, 95% CI: 1.266 to 3.613, p = 0.004). Diabetic patients with ACS have more plaques with characteristics of plaque vulnerability, different composition of plaques, and have increased inflammatory status compared with nondiabetic patients with ACS.