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

2017; SAGE Publishing; Volume: 15; Issue: 1 Linguagem: Inglês

10.1177/1479164117735493

1752-8984

Stefano Savonitto, Nuccia Morici, Anna Nozza, Francesco Cosentino, Pasquale Perrone Filardi, Ernesto Murena, Giorgio Morocutti, Marco Ferri, Claudio Cavallini, Marinus J.C. Eijkemans, Barbara E. Stähli, Ilse C. Schrieks, Tadashi Toyama, HJ Lambers Heerspink, Klas Malmberg, Gregory G. Schwartz, A. Michael Lincoff, Lars Rydén, Jean‐Claude Tardif, Diederick E. Grobbee,

Cardiovascular Function and Risk Factors

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.