• NEWS . 01 Jun 2020
  • Diabetic status linked to higher mortality in elderly ACS patients undergoing PCI: ELDERLY ACS 2 trial

  • Among elderly patients with acute coronary syndrome (ACS), diabetic status was associated with higher rates of comorbidities, more severe cardiovascular (CV) risk profile and major bleeding complications fully accounting for the absolute increase in mortality. In fact, diabetes mellitus did not appear as an independent predictor of survival in advanced age.

    This is according to the Elderly-ACS 2 trial, a randomized, open-label, blinded endpoint study that aimed to evaluate the prognostic impact of diabetes on clinical outcomes. 

    A total of 1,443 patients across 32 centres in Italy were included, of which 419 (29%) had diabetes. Diabetic status was significantly associated with: major CV risk factors and history of previous coronary disease; presentation with non-ST segment elevation myocardial infarction (p = 0.01); more extensive coronary disease (p = 0.02); more advanced Killip class at presentation (p= 0.003); and use of statins at admission (p= 0.004) and diuretics at discharge (p< 0.001). 

    Furthermore, diabetic status was associated with an absolute increase in CV mortality rate compared with patients without diabetes (5.5% vs 3.3%; hazard ratio [HR], 1.7; 95% confidence interval [CI], 0.99–2.8; p = 0.054), especially among those treated with clopidogrel (HR, 1.89; 95% CI, 0.93–3.87; p= 0.08). However, this difference disappeared after correction for baseline differences (adjusted HR, 1.1; 95% CI, 0.4–2.9; p = 0.86). Similar findings were also observed for: all-cause death, recurrent myocardial infarction, and rehospitalization for CV event or stent thrombosis within 12 months after index admission; although bleeding complications were significantly more frequent in patients with diabetes (HR, 2.02; 95% CI, 1.14–3.6; p= 0.02; adjusted HR , 2.1; 95% CI, 1.01–4.3; p = 0.05). Lastly, no significant interaction was observed between type of dual antiplatelet therapy, diabetic status and outcome.

    De Luca G, et al. Impact of diabetes on clinical outcome among elderly patients with acute coronary syndrome treated with percutaneous coronary intervention: insights from the ELDERLY ACS 2 trial. J Cardiovasc Med (Hagerstown) 2020;21:453–459.