Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes

• Published in: Diabetes & vascular disease research 2018-01, Vol.15 (1), p.14-23
• Main Authors: Savonitto, Stefano, Morici, Nuccia, Nozza, Anna, Cosentino, Francesco, Perrone Filardi, Pasquale, Murena, Ernesto, Morocutti, Giorgio, Ferri, Marco, Cavallini, Claudio, Eijkemans, Marinus JC, Stähli, Barbara E, Schrieks, Ilse C, Toyama, Tadashi, Lambers Heerspink, HJ, Malmberg, Klas, Schwartz, Gregory G, Lincoff, A Michael, Ryden, Lars, Tardif, Jean Claude, Grobbee, Diederick E
• Format: Article
• Language: English
• Subjects: Acute Coronary Syndrome - blood; Acute Coronary Syndrome - diagnosis; Acute Coronary Syndrome - mortality; Acute Coronary Syndrome - therapy; Aged; Biomarkers - blood; Blood Glucose - drug effects; Blood Glucose - metabolism; Chi-Square Distribution; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - diagnosis; Diabetes Mellitus, Type 2 - drug therapy; Diabetes Mellitus, Type 2 - mortality; Double-Blind Method; Female; Glycated Hemoglobin A - metabolism; Humans; Hypoglycemic Agents - therapeutic use; Kaplan-Meier Estimate; Male; Medicin och hälsovetenskap; Middle Aged; Multivariate Analysis; Myocardial Revascularization; Natriuretic Peptide, Brain - blood; Oxazoles - therapeutic use; Peptide Fragments - blood; Predictive Value of Tests; Proportional Hazards Models; Risk Assessment; Risk Factors; Thiophenes - therapeutic use; Time Factors; Treatment Outcome
• ISSN: 1479-1641; 1752-8984; 1752-8984
• DOI: 10.1177/1479164117735493

Aim: To define the predictors of long-term mortality in patients with type 2 diabetes mellitus and recent acute coronary syndrome. Methods and results: A total of 7226 patients from a randomized trial, testing the effect on cardiovascular outcomes of the dual peroxisome proliferator–activated receptor agonist aleglitazar in patients with type 2 diabetes mellitus and recent acute coronary syndrome (AleCardio trial), were analysed. Median follow-up was 2 years. The independent mortality predictors were defined using Cox regression analysis. The predictive information provided by each variable was calculated as percent of total chi-square of the model. All-cause mortality was 4.0%, with cardiovascular death contributing for 73% of mortality. The mortality prediction model included N-terminal proB-type natriuretic peptide (adjusted hazard ratio = 1.68; 95% confidence interval = 1.51–1.88; 27% of prediction), lack of coronary revascularization (hazard ratio = 2.28; 95% confidence interval = 1.77–2.93; 18% of prediction), age (hazard ratio = 1.04; 95% confidence interval = 1.02–1.05; 15% of prediction), heart rate (hazard ratio = 1.02; 95% confidence interval = 1.01–1.03; 10% of prediction), glycated haemoglobin (hazard ratio = 1.11; 95% confidence interval = 1.03–1.19; 8% of prediction), haemoglobin (hazard ratio = 1.01; 95% confidence interval = 1.00–1.02; 8% of prediction), prior coronary artery bypass (hazard ratio = 1.61; 95% confidence interval = 1.11–2.32; 7% of prediction) and prior myocardial infarction (hazard ratio = 1.40; 95% confidence interval = 1.05–1.87; 6% of prediction). Conclusion: In patients with type 2 diabetes mellitus and recent acute coronary syndrome, mortality prediction is largely dominated by markers of cardiac, rather than metabolic, dysfunction.