Stefano Savonitto1, Nuccia Morici2, Anna Nozza3, Francesco Cosentino4, Pasquale Perrone Filardi5, Ernesto Murena6, Giorgio Morocutti7, Marco Ferri8, Claudio Cavallini9, Marinus Jc Eijkemans10, Barbara E Stähli11, Ilse C Schrieks10, Tadashi Toyama12, H J Lambers Heerspink13, Klas Malmberg4, Gregory G Schwartz14, A Michael Lincoff15, Lars Ryden4, Jean Claude Tardif3,11, Diederick E Grobbee10. 1. 1 Division of Cardiology, Ospedale Alessandro Manzoni, Lecco, Italy. 2. 2 Cardiovascular Department, Ospedale Niguarda Ca' Granda, Milano, Italy. 3. 3 Montreal Health Innovations Coordinating Center (MHICC), Montreal, QC, Canada. 4. 4 Cardiology Unit, Department of Medicine, Karolinska University Hospital, Stockholm, Sweden. 5. 5 Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy. 6. 6 Division of Cardiology, Ospedale Santa Maria delle Grazie, Pozzuoli, Italy. 7. 7 Cardiothoracic Department, University Hospital 'Santa Maria della Misericordia', Udine, Italy. 8. 8 Division of Cardiology, IRCCS Arcispedale S. Maria Nuova, Reggio Emilia, Italy. 9. 9 Division of Cardiology, Ospedale Santa Maria della Misericordia, Perugia, Italy. 10. 10 Julius Center for Health Sciences and Primary Care and Julius Clinical, University Medical Center Utrecht, Utrecht, The Netherlands. 11. 11 Montreal Heart Institute, Université de Montréal, Montreal, QC, Canada. 12. 12 The George Institute for Global Health, Camperdown, NSW, Australia. 13. 13 Department of Clinical Pharmacy and Pharmacology, University Medical Center Groningen, Groningen, The Netherlands. 14. 14 Veterans Affairs Medical Center, School of Medicine, University of Colorado, Denver, CO, USA. 15. 15 Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, OH, USA.
Abstract
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.
RCT Entities:
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.
Authors: Aurora Baluja; Moisés Rodríguez-Mañero; Alberto Cordero; Bahij Kreidieh; Diego Iglesias-Alvarez; Jose M García-Acuña; Alvaro Martínez-Gómez; Rosa Agra-Bermejo; Leyre Alvarez-Rodríguez; Charigan Abou-Jokh; Mónica López-Ratón; Francisco Gude-Sampedro; Julián Alvarez-Escudero; Jose R González-Juanatey Journal: Diab Vasc Dis Res Date: 2019-12-16 Impact factor: 3.291