Ramesh Nadarajah, Peter Ludman, Cécile Laroche, Yolande Appelman, Salvatore Brugaletta, Andrzej Budaj, Hector Bueno, Kurt Huber, Vijay Kunadian, Sergio Leonardi, Maddalena Lettino, Dejan Milasinovic, Ramzi Ajjan, Nikolaus Marx, Chris P Gale
{"title":"糖尿病与 NSTEMI 患者的表现、护理和预后：欧洲心脏病学会急性心血管护理协会-欧洲经皮心血管介入协会欧洲观察研究计划 NSTEMI 登记。","authors":"Ramesh Nadarajah, Peter Ludman, Cécile Laroche, Yolande Appelman, Salvatore Brugaletta, Andrzej Budaj, Hector Bueno, Kurt Huber, Vijay Kunadian, Sergio Leonardi, Maddalena Lettino, Dejan Milasinovic, Ramzi Ajjan, Nikolaus Marx, Chris P Gale","doi":"10.1093/ehjqcco/qcae002","DOIUrl":null,"url":null,"abstract":"<p><strong>Aims: </strong>Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.</p><p><strong>Methods and results: </strong>Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.</p><p><strong>Conclusion: </strong>NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.</p>","PeriodicalId":11869,"journal":{"name":"European Heart Journal - Quality of Care and Clinical Outcomes","volume":" ","pages":"709-722"},"PeriodicalIF":4.8000,"publicationDate":"2024-12-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology.\",\"authors\":\"Ramesh Nadarajah, Peter Ludman, Cécile Laroche, Yolande Appelman, Salvatore Brugaletta, Andrzej Budaj, Hector Bueno, Kurt Huber, Vijay Kunadian, Sergio Leonardi, Maddalena Lettino, Dejan Milasinovic, Ramzi Ajjan, Nikolaus Marx, Chris P Gale\",\"doi\":\"10.1093/ehjqcco/qcae002\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Aims: </strong>Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.</p><p><strong>Methods and results: </strong>Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.</p><p><strong>Conclusion: </strong>NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.</p>\",\"PeriodicalId\":11869,\"journal\":{\"name\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"volume\":\" \",\"pages\":\"709-722\"},\"PeriodicalIF\":4.8000,\"publicationDate\":\"2024-12-19\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"European Heart Journal - Quality of Care and Clinical Outcomes\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1093/ehjqcco/qcae002\",\"RegionNum\":2,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"European Heart Journal - Quality of Care and Clinical Outcomes","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1093/ehjqcco/qcae002","RegionNum":2,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
Diabetes mellitus and presentation, care and outcomes of patients with NSTEMI: the Association for Acute Cardiovascular Care-European Association of Percutaneous Cardiovascular Interventions EURObservational Research Programme NSTEMI Registry of the European Society of Cardiology.
Aims: Diabetes mellitus (diabetes) is common amongst patients with non-ST-segment elevation myocardial infarction (NSTEMI). We describe presentation, care, and outcomes of patients admitted with NSTEMI by diabetes status.
Methods and results: Prospective cohort study including 2928 patients (1104 with prior diabetes, 1824 without) admitted to hospital with NSTEMI from 287 centres in 59 countries. Quality of care was evaluated based on 12 guideline-recommended care interventions. Outcomes included in-hospital acute heart failure, cardiogenic shock, repeat myocardial infarction, stroke/transient ischaemic attack (TIA), BARC Type ≥ 3 bleeding and death, as well as 30-day mortality. Patients with diabetes had higher comorbidity burden and more frequently presented with Killip Class II-IV heart failure (10.2% vs. 3.7%, P < 0.001), haemodynamic instability (7.1% vs. 3.7%, P < 0.001), and ongoing chest pain (43.1% vs. 37.0%, P < 0.001), than those without diabetes. Overall, care quality received was similar by diabetes status (60.0% vs. 60.5% received ≥ 80% of eligible care interventions, P = 0.786), but patients with diabetes experienced higher rates of in-hospital acute heart failure (15.3% vs. 6.8% P < 0.001), cardiogenic shock (4.5% vs. 2.5%, P = 0.002), stroke/TIA (2.0% vs. 0.8%, P = 0.006), and death (2.5% vs. 1.4%, P = 0.022), and higher 30-day mortality (3.3% vs. 2.0%, P = 0.025). Of NSTEMI with diabetes, only 1.9% and 9.0% received prescription for glucagon-like peptide-1 receptor agonists and sodium-glucose co-transporter-2 inhibitors, respectively, on discharge, and only 45.9% were referred for cardiac rehabilitation.
Conclusion: NSTEMI patients with diabetes, compared with those without, present more clinically unwell and have worse outcomes despite receiving equal quality of care. Prescription of cardiovascular-protective glycaemic agents is an actionable target to reduce risk of further events.
期刊介绍：
European Heart Journal - Quality of Care & Clinical Outcomes is an English language, peer-reviewed journal dedicated to publishing cardiovascular outcomes research. It serves as an official journal of the European Society of Cardiology and maintains a close alliance with the European Heart Health Institute. The journal disseminates original research and topical reviews contributed by health scientists globally, with a focus on the quality of care and its impact on cardiovascular outcomes at the hospital, national, and international levels. It provides a platform for presenting the most outstanding cardiovascular outcomes research to influence cardiovascular public health policy on a global scale. Additionally, the journal aims to motivate young investigators and foster the growth of the outcomes research community.
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