Current Impact of Diabetes on In-Hospital Survival and Complication Outcomes in Acute Coronary Syndrome (ACS)

Prevalence of diabetes is increasing worldwide and outcomes after ACS are thought to improve. We assessed the prevalence of DM, previously known (known-DM) or newly-diagnosed (new-DM), in all patients (n=1,017, males 66.6%) admitted for ACS at the Intensive Coronary Care Unit of the Verona University Hospital from 1/1/2015 to 12/31/2016. DM was ascertained according to previous diagnosis, glucose-lowering therapy at admission/discharge or random plasma glucose ≥11.1 mmol/L. The association of DM with in-hospital death, infectious/cardiorespiratory complications, duration and costs of hospitalization was tested in all patients and separately in known-DM and new-DM. The prevalence of DM was 27.2% (74.1% known-DM; 25.9% new-DM). In-hospital death rate was 4.72%. Compared to nondiabetic patients, those with DM showed an increased risk of death (7.6 vs. 3.6%; OR 2.17 95% CI, 1.20-3.90) and complications (34.4 vs. 23.9%; OR 1.67, 1.23-2.28), a longer hospital stay (median[IQR], 11 [7-17] vs. 8 [6-13] days), higher hospitalization costs (mean±SD, € 10,033±7,626 vs. 8,513±6,363) and more need of rehabilitation at discharge (10.8 vs. 5.9%); P<0.for all comparisons. After multivariable adjustment (age, sex, BMI, e-GFR, LVEF, previous MI, lipid-lowering and anti-hypertensive drugs), DM remained an independent predictor of in-hospital death (OR 5.81, 1.31-25.7) but not complications (OR 1.14, 0.78-1.69). All study outcomes resulted significantly worse in new-DM vs. known-DM. In the former, ORs for in-hospital death and complications vs. nondiabetic controls were 2.40 (0.96-6.02) and 1.71 (0.99-2.96), respectively, while in known-DM figures were 2.09 (1.09-3.99) and 1.66 (1.18-2.33), respectively. These data highlight the extremely high frequency of DM in ACS and underscore the urgent need of strategies to anticipate DM diagnosis in patients at high cardiovascular risk.