Type 2 diabetes mellitus and clinical outcomes in patients with acute coronary syndrome during a one-year observation: own data and meta-analysis

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Abstract

Article represents data on the impact of type 2 diabetes mellitus (T2DM) on the occurrence of adverse cardiovascular events within a year after acute coronary syndrome (ACS) based on the results of our own observational study ORACLE II (2014–2017). The obtained results are compared with the data of previously performed studies with similar aims and design.

The aim: to analyze clinical outcomes within a year after ACS occurrence in T2DM patients from Russian population and to compare the obtained results with the data of the world literature.

Material and methods. Meta-analysis of randomized multicenter prospective studies for 2008–2017 was performed. Data from 7 randomized clinical trials in patients who had undergone ACS and had a history of confirmed diagnosis of T2DM were used. Subsequently, the clinical outcomes of patients were analyzed during the year of observation after the index event.

Results. Patients with diabetes mellitus were significantly more likely to die from any cause within a year after ACS occurrence (risk difference (RD) 0.03; 95% confidence interval (CI): 0.01–0.04; p < 0.001), as well as directly from cardiovascular causes (RD 0.012; 95% CI: 0.007–0.017, p < 0.001) comparatively to patients without diabetes. Moreover, patients with type 2 diabetes mellitus had an increased risk of recurrent ACS (RR 0.013; 95% CI: 0.002–0.025, p = 0.019) and myocardial revascularization during the year of observation (RR 0.023; 95% CI: 0.017–0.029, p < 0.001), but not acute cerebrovascular accident (RR 0.0053; 95% CI: 0.0008–0.0099, p = 0.021). No significant differences were found in the incidence of bleeding in patients with and without T2DM (RR 0.004; 95% CI: 0.001–0.008, p = 0.145).

Conclusion. Presence of T2DM significantly increases the risk of overall mortality and cardiovascular events, including fatal ones, within a year after ACS, but the frequency of adverse outcomes is very variable.

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About the authors

Yuri M. Chichkov

United hospital with a polyclinic of the Facilities and Property Management Office under the RF President

Author for correspondence.
Email: umchichkov@mail.ru
ORCID iD: 0000-0002-0593-5193
SPIN-code: 1295-8403

MD, cardiologist

Russian Federation, Moscow

Larisa O. Minushkina

Central State Medical Academy of the Facilities and Property Management Office under the RF President

Email: minushkina@mail.ru
ORCID iD: 0000-0002-4203-3586
SPIN-code: 3654-8920

MD, Dr. Sci. (Medicine), professor of the Department of therapy, cardiology and functional diagnostics

Russian Federation, Moscow

Victoria A. Brazhnik

Central State Medical Academy of the Facilities and Property Management Office under the RF President; N.E. Bauman City Clinical Hospital No. 29 of the Department of Healthcare of Moscow

Email: vabrahznik@bk.ru
ORCID iD: 0000-0003-4144-4719
SPIN-code: 5627-9617

MD, Dr. Sci. (Medicine), associate professor of the Department of therapy, cardiology and functional diagnostics, chief physician

Russian Federation, Moscow; Moscow

Marina A. Chichkova

Clinical hospital No. 1 of the Facilities and Property Management Office under the RF President; Astrakhan State Medical University of the Ministry of Healthcare of Russia

Email: m.chichkova@mail.ru
ORCID iD: 0000-0002-6962-3260
SPIN-code: 5244-5358

MD, Dr. Sci. (Medicine), professor of the Department of cardiology, head of the Department of therapy No. 2

Russian Federation, Moscow; Astrakhan

Niyaz R. Khasanov

Kazan State Medical University of the Ministry of Healthcare of Russia

Email: ybzp@mail.ru
ORCID iD: 0000-0001-8582-708X
SPIN-code: 2501-3397

MD, Dr. Sci. (Medicine), associate professor, head of the Department of internal medicine propaedeutics

Russian Federation, Kazan

Olga I. Boeva

Central State Medical Academy of the Facilities and Property Management Office under the RF President

Email: box0271@mail.ru
ORCID iD: 0000-0002-1816-8309
SPIN-code: 4110-8448

MD, Dr. Sci. (Medicine), professor of the Department of therapy, cardiology and functional diagnostics

Russian Federation, Moscow

Elena D. Kosmacheva

Kuban State Medical University of the Ministry of Healthcare of Russia

Email: kosmachova_h@mail.ru
ORCID iD: 0000-0001-5690-2482
SPIN-code: 5277-2982

MD, Dr. Sci. (Medicine), professor, head of the Department of therapy No. 1 of the Faculty of advanced training and professional retraining of specialists

Russian Federation, Krasnodar

Dmitry A. Zateyshchikov

Central State Medical Academy of the Facilities and Property Management Office under the RF President; N.E. Bauman City Clinical Hospital No. 29 of the Department of Healthcare of Moscow

Email: dz@bk.ru
ORCID iD: 0000-0001-7065-2045
SPIN-code: 1694-3031

MD, Dr. Sci. (Medicine), professor, head of the Department of therapy, cardiology and functional diagnostics, head of the Primary Vascular Department

Russian Federation, Moscow; Moscow

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Supplementary files

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2. Fig. 1. PRISMA flow diagram for this study.

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3. Fig. 2. Meta-analysis of the proportion of patients with type 2 diabetes mellitus in the included studies: A - Funnel plot, B - Forest plot.

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4. Fig. 3. Differences in all-cause mortality risk during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p < 0.001, I2 = 87%)

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5. Fig. 4. Differences in cardiovascular mortality risk during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p < 0.001, I2 = 59%)

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6. Fig. 5. Differences in recurrent coronary event risk during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p = 0.019, I2 = 84%)

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7. Fig. 6. Differences in risk of repeat revascularizations during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p < 0.001, I2 = 55%)

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8. Fig. 7. Differences in stroke risk during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p = 0.021, I2 = 10%)

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9. Fig. 8. Differences in serious bleeding risk during one year of follow-up in patients with acute coronary syndrome with and without type 2 diabetes mellitus: A - Funnel plot, B - Forest plot (p = 0.145, I2 = 35%)

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