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Should PRECISE-DAPT be included for long-term prognostic stratification of diabetic patients with NSTEACS?

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Abstract

Aims

There are insufficient data regarding risk scores validation in patients with diabetes mellitus and non-ST elevation acute coronary syndrome (NSTEACS). We performed a diabetes mellitus-specific analysis of cardiovascular outcomes after NSTEACS. We tested the predictive power of the Global Registry of Acute Coronary Events (GRACE) and PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy (PRECISE-DAPT) scores.

Methods

This work is a retrospective analysis that included 7,415 consecutive NSTEACS patients from two Spanish Universitarian hospitals between the years 2003 and 2017. The area under the ROC curve among with and without diabetes mellitus patients was calculated, to evaluate the predictive power of both scores. 

Results

Among the study participants, 2124 patients (28.0%) were diabetic. The median follow-up was 54,3 months (IQR 24,7–80,0 months). Diabetic patients were more women (30.5% vs. 25.7%) and older (70.0 ± 10.8 vs. 65.3 ± 13.2 years old); they had higher GRACE (146 ± 36 vs. 137 ± 36), PRECISE-DAPT (15 ± 7 vs. 18 ± 9) at admission. Early invasive coronary angiography (≤ 24 h after admission) was performed more frequently in non-diabetic. We tested the predictive power of the GRACE and PRECISE-DAPT risk scores among diabetic and non-diabetic. PRECISE-DAPT risk score showed a good predictive power for all-cause mortality, cardiovascular mortality and MACE in diabetic admitted with NSTEACS, without differences compared to non-diabetic.

Conclusions

PRECISE-DAPT risk score has an appropriate predictive power in diabetic patients admitted with NSTEACS compared to non-diabetic NSTEACS. However, GRACE would be predictive worse in diabetic during long-term follow-up in a large contemporary registry.

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Abbreviations

NSTEACS:

Non-ST-segment elevation acute coronary syndrome

ACS:

Acute coronary syndrome

DM:

Diabetes mellitus

ESC:

European Society of Cardiology

GRACE:

Global Registry of Acute Coronary Events

PRECISE-DAPT:

PREdicting bleeding Complications In patients undergoing Stent implantation and subsEquent Dual Anti-Platelet Therapy

MACE:

Major adverse cardiac events

HF:

Heart Failure

AUC:

Area under the ROC curve

NRI:

Net Reclassification Improvement

IDI:

Integrated Discrimination Improvement

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Authors and Affiliations

  1. Cardiology Department, Complejo Hospitalario Universitario de Santiago de Compostela, Rúa da Choupana s/n. 15703, Santiago de Compostela, Spain

    Federico García‑Rodeja Arias, Belén Álvarez Álvarez, Teba González Ferrero, Jesús Martinón Martínez, Óscar Otero García, Pablo Tasende Rey, Carla Eugenia Cacho Antonio, Charigan Abou Jokh Casas, Víctor Jiménez Ramos, Belén Cid Álvarez, Diego Iglesias Álvarez, Rosa María Agra Bermejo, Pedro Rigueiro Veloso, José María García Acuña & José Ramón González Juanatey

  2. Biomedical Research Networking Center On Cardiovascular Diseases (CIBERCV), Madrid, Spain

    Federico García‑Rodeja Arias, Belén Álvarez Álvarez, Teba González Ferrero, Jesús Martinón Martínez, Óscar Otero García, Pablo Tasende Rey, Carla Eugenia Cacho Antonio, Charigan Abou Jokh Casas, Pilar Zuazola, Víctor Jiménez Ramos, Alberto Cordero, David Escribano, Belén Cid Álvarez, Diego Iglesias Álvarez, Rosa María Agra Bermejo, Pedro Rigueiro Veloso, José María García Acuña & José Ramón González Juanatey

  3. Cardiology Department, University Hospital of San Juan, Alicante, Spain

    Pilar Zuazola, Alberto Cordero & David Escribano

  4. Epidemiology Department, University Clinical Hospital of Santiago de Compostela, Santiago de Compostela, Spain

    Francisco Gude Sampedro

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  1. Federico García‑Rodeja Arias
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Corresponding author

Correspondence to Federico García‑Rodeja Arias.

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This manuscript has no conflicts of interest.

Ethical standard

The ethics committee of the coordinators at each hospital approved the study protocol.

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Informed consent was collected from the individuals participating in the study.

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Managed by Antonio Secchi .

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García‑Rodeja Arias, F., Álvarez Álvarez, B., González Ferrero, T. et al. Should PRECISE-DAPT be included for long-term prognostic stratification of diabetic patients with NSTEACS?. Acta Diabetol 59, 163–170 (2022). https://doi.org/10.1007/s00592-021-01792-w

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  • DOI: https://doi.org/10.1007/s00592-021-01792-w

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