Skip to main content

Advertisement

SpringerLink
Log in

Diabetes Mellitus and Acute Coronary Syndrome: Lessons From Randomized Clinical Trials

  • Management of Macrovascular Disease in Diabetes (S Inzucchi and R Goldberg, Section Editors)
  • Published:
Current Diabetes Reports Aims and scope Submit manuscript

Abstract

Diabetes mellitus is a major independent risk factor for acute coronary syndrome (ACS). In addition, diabetic patients with ACS suffer from increased mortality compared to their nondiabetic peers. Driven by multiple pathophysiological disturbances, such patients are predisposed to a proinflammatory, prothrombotic state, which may lead to plaque rupture. To counteract this more complex biology, several therapies and strategies have emerged, with some having unique preferential benefits in this population. Antiplatelet agents such as aspirin and clopidogrel have long been standard of care. Dose adjustment of these therapies remains the subject of continued research. Along with medical therapy, ACS diabetic patients preferentially benefit from primary percutaneous intervention compared to fibrinolysis. However, with advances in reperfusion techniques, the optimal strategy has yet to be determined. With these differences in ACS treatment responses, diabetic individuals may not just be a high-risk group, but may actually constitute a fundamentally different population, requiring dedicated clinical trials and individualized treatment regimens.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. Centers for Disease Control and Prevention. National diabetes fact sheet: general information and national estimates on diabetes in the United States, 2003. Rev ed. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2004.

    Google Scholar 

  2. Centers for Disease Control and Prevention. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention; 2011.

    Google Scholar 

  3. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979;241:2035–8.

    Article  PubMed  CAS  Google Scholar 

  4. Howard BV, Rodriguez BL, Bennett PH, et al. Circulation. Prevention conference VI: diabetes and cardiovascular disease: writing group I: epidemiology. Circulation. 2002;105:e132–7.

    Article  PubMed  Google Scholar 

  5. Haffner SM, Lehto S, Rönnemaa T, et al. Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects with and without prior myocardial infarction. N Engl J Med. 1998;339:229–34.

    Article  PubMed  CAS  Google Scholar 

  6. Bartnik M, Rydén L, Ferrari R, Euro Heart Survey Investigators, et al. The prevalence of abnormal glucose regulation in patients with coronary artery disease across Europe. The Euro Heart Survey on diabetes and the heart. Eur Heart J. 2004;25:1880–90.

    Article  PubMed  CAS  Google Scholar 

  7. Cohen MG, Filby SJ, Roe MT, et al. The paradoxical use of cardiac catheterization in patients with non-ST-elevation acute coronary syndromes: lessons from the Can Rapid Stratification of Unstable Angina Patients Suppress Adverse Outcomes With Early Implementation of the ACC/AHA guidelines (CRUSADE) quality improvement initiative. Am Heart J. 2009;158:263–70.

    Article  PubMed  Google Scholar 

  8. Norhammar A, Malmberg K, Diderholm E, et al. Diabetes mellitus: the major risk factor in unstable coronary artery disease even after consideration of the extent of coronary artery disease and benefits of revascularization. J Am Coll Cardiol. 2004;43:585–91.

    Article  PubMed  Google Scholar 

  9. Granger CB, Califf RM, Young S, et al. Outcome of patients with diabetes mellitus and acute myocardial infarction treated with thrombolytic agents. The Thrombolysis and Angioplasty in Myocardial Infarction (TAMI) study group. J Am Coll Cardiol. 1993;21:920–5.

    Article  PubMed  CAS  Google Scholar 

  10. Franklin K, Goldberg RJ, Spencer F, et al. GRACE investigators implications of diabetes in patients with acute coronary syndromes. The global registry of acute coronary events. Arch Intern Med. 2004;164:1457–63.

    Article  PubMed  Google Scholar 

  11. Mak KH, Moliterno DJ, Granger CB, et al. Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction. GUSTO-I investigators. Global utilization of streptokinase and tissue plasminogen activator for occluded coronary arteries. J Am Coll Cardiol. 1997;30:171–9.

    Article  PubMed  CAS  Google Scholar 

  12. •• Donahoe SM, Stewart GC, McCabe CH, et al. Diabetes and mortality following acute coronary syndromes. JAMA. 2007;298:765–75. This study pooled patient-level data from multiple trials demonstrating that diabetes confers a significant adverse prognosis in ACS.

    Article  PubMed  CAS  Google Scholar 

  13. Marso SP, Safley DM, House JA, et al. Suspected acute coronary syndrome patients with diabetes and normal troponin-I levels are at risk for early and late death: identification of a new high-risk acute coronary syndrome population. Diabetes Care. 2006;29:1931–2.

    Article  PubMed  Google Scholar 

  14. Brogan Jr GX, Peterson ED, Mulgund J, et al. Treatment disparities in the care of patients with and without diabetes presenting with non-ST-segment elevation acute coronary syndromes. Diabetes Care. 2006;29:9–14.

    Article  PubMed  Google Scholar 

  15. Farkouh ME, Aneja A, Reeder GS, et al. Usefulness of diabetes mellitus to predict long-term outcomes in patients with unstable angina pectoris. Am J Cardiol. 2009;104:492–7.

    Article  PubMed  Google Scholar 

  16. Moreno PR, Fuster V. New aspects in the pathogenesis of diabetic atherothrombosis. J Am Coll Cardiol. 2004;44:2293–300.

    Article  PubMed  CAS  Google Scholar 

  17. Johnstone MT, Creager SJ, Scales KM, et al. Impaired endothelium-dependent vasodilation in patients with insulin-dependent diabetes mellitus. Circulation. 1993;88:2510–6.

    PubMed  CAS  Google Scholar 

  18. Williams SB, Cusco JA, Roddy MA, et al. Impaired nitric oxide-mediated vasodilation in patients with noninsulin- dependent diabetes mellitus. J Am Coll Cardiol. 1996;27:567–74.

    Article  PubMed  CAS  Google Scholar 

  19. Haffner SM, Stern MP, Hazuda HP, et al. Cardiovascular risk factors in confirmed prediabetic individuals. Does the clock for coronary heart disease start ticking before the onset of clinical diabetes? JAMA. 1990;263:2893–8.

    Article  PubMed  CAS  Google Scholar 

  20. Balletshofer BM, Rittig K, Enderle MD, et al. Endothelial dysfunction is detectable in young normotensive first-degree relatives of subjects with type 2 diabetes in association with insulin resistance. Circulation. 2000;101:1780–4.

    PubMed  CAS  Google Scholar 

  21. Davignon J, Ganz P. Role of endothelial dysfunction in atherosclerosis. Circulation. 2004;109:III27–32.

    PubMed  Google Scholar 

  22. Zeiher AM, Fisslthaler B, Schray-Utz B, et al. Nitric oxide modulates the expression of monocyte chemoattractant protein 1 in cultured human endothelial cells. Circ Res. 1995;76:980–6.

    PubMed  CAS  Google Scholar 

  23. Libby P. Changing concepts of atherogenesis. J Intern Med. 2000;247:349–58.

    Article  PubMed  CAS  Google Scholar 

  24. Saito I, Folsom AR, Brancati FL, et al. Nontraditional risk factors for coronary heart disease incidence among patients with diabetes: the Atherosclerosis Risk In Communities (ARIC) study. Ann Intern Med. 2000;133:81–91.

    PubMed  CAS  Google Scholar 

  25. Moreno PR, Murcia AM, Palacios IF, et al. Coronary composition and macrophage infiltration in atherectomy specimens from patients with diabetes mellitus. Circulation. 2000;102:2180–4.

    PubMed  CAS  Google Scholar 

  26. Sagel J, Colwell JA, Crook L, Laimins M. Increased platelet aggregation in early diabetes mellitus. Ann Intern Med. 1975;82:733–8.

    PubMed  CAS  Google Scholar 

  27. el Khawand C, Jamart J, Donckier J, et al. Hemostasis variables in type I diabetic patients without demonstrable vascular complications. Diabetes Care. 1993;16:1137–45.

    Article  PubMed  Google Scholar 

  28. Aoki I, Shimoyama K, Aoki N, et al. Platelet-dependent thrombin generation in patients with diabetes mellitus: effects of glycemic control on coagulability in diabetes. J Am Coll Cardiol. 1996;27:560–6.

    Article  PubMed  CAS  Google Scholar 

  29. Oskarsson HJ, Hofmeyer TG. Platelets from patients with diabetes mellitus have impaired ability to mediate vasodilation. J Am Coll Cardiol. 1996;27:1464–70.

    Article  PubMed  CAS  Google Scholar 

  30. Silva JA, Escobar A, Collins TJ, et al. Unstable angina: a comparison of angioscopic findings between diabetic and nondiabetic patients. Circulation. 1995;92:1731–6.

    PubMed  CAS  Google Scholar 

  31. Capes SE, Hunt D, Malmberg K, Gerstein HC. Stress hyperglycaemia and increased risk of death after myocardial infarction in patients with and without diabetes: a systematic overview. Lancet. 2000;355:773–8.

    Article  PubMed  CAS  Google Scholar 

  32. Kosiborod M, Rathore SS, Inzucchi SE, et al. Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction: implications for patients with and without recognized diabetes. Circulation. 2005;111:3078–86.

    Article  PubMed  CAS  Google Scholar 

  33. Deedwania P, Kosiborod M, Barrett E, et al. Hyperglycemia and acute coronary syndrome: a scientific statement from the American Heart Association Diabetes Committee of the council on nutrition, physical activity, and metabolism. Circulation. 2008;117:1610–9.

    Article  PubMed  Google Scholar 

  34. Mehta SR, Cannon CP, Fox KA, et al. Routine vs. selective invasive strategies in patients with acute coronary syndromes: a collaborative meta-analysis of randomized trials. JAMA. 2005;293:2908–17.

    Article  PubMed  CAS  Google Scholar 

  35. Cheung NW, Wong VW, McLean M. The hyperglycemia: intensive insulin infusion in infarction (HI-5) study: a randomized controlled trial of insulin infusion therapy for myocardial infarction. Diabetes Care. 2006;29:765–70.

    Article  PubMed  CAS  Google Scholar 

  36. Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucometrics in patients hospitalized with acute myocardial infarction: defining the optimal outcomes-based measure of risk. Circulation. 2008;117:1018–27.

    Article  PubMed  CAS  Google Scholar 

  37. • Kosiborod M, Inzucchi SE, Krumholz HM, et al. Glucose normalization and outcomes in patients with acute myocardial infarction. Arch Intern Med. 2009;169:438–46. Using a large database, this study demonstrated that normalizing glucose in diabetic ACS patients is associated with increased survival.

    Article  PubMed  CAS  Google Scholar 

  38. Fath-Ordoubadi F, Beatt KJ. Glucose-insulin-potassium therapy for treatment of acute myocardial infarction: an overview of randomized placebo-controlled trials. Circulation. 1997;96:1152–6.

    PubMed  CAS  Google Scholar 

  39. Zhao YT, Weng CL, Chen ML, et al. Comparison of glucose-insulin-potassium and insulin-glucose as adjunctive therapy in acute myocardial infarction: a contemporary meta-analysis of randomised controlled trials. Heart. 2010;96:1622–6.

    Article  PubMed  CAS  Google Scholar 

  40. Díaz R, Goyal A, Mehta SR, et al. Glucose-insulin-potassium therapy in patients with ST-segment elevation myocardial infarction. JAMA. 2007;298:2399–405.

    Article  PubMed  Google Scholar 

  41. Malmberg K, Rydén L, Efendic S, et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol. 1995;26:57–65.

    Article  PubMed  CAS  Google Scholar 

  42. Malmberg K. Prospective randomised study of intensive insulin treatment on long term survival after acute myocardial infarction in patients with diabetes mellitus. DIGAMI (Diabetes Mellitus, Insulin Glucose Infusion in Acute Myocardial Infarction) study group. BMJ. 1997;314:1512–5.

    Article  PubMed  CAS  Google Scholar 

  43. Malmberg K, Rydén L, Wedel H, et al. DIGAMI 2 investigators. Intense metabolic control by means of insulin in patients with diabetes mellitus and acute myocardial infarction (DIGAMI 2): effects on mortality and morbidity. Eur Heart J. 2005;26:650–61.

    Article  PubMed  CAS  Google Scholar 

  44. Gerstein HC, Miller ME, Byington RP, et al. Effects of intensive glucose lowering in type 2 diabetes. N Engl J Med. 2008;358:2545–59.

    Article  PubMed  CAS  Google Scholar 

  45. Finfer S, Chittock DR, Su SY, et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med. 2009;360:1283–97.

    Article  PubMed  Google Scholar 

  46. Ray KK, Seshasai SR, Wijesuriya S, et al. Effect of intensive control of glucose on cardiovascular outcomes and death in patients with diabetes mellitus: a meta-analysis of randomised controlled trials. Lancet. 2009;373:1765–72.

    Article  PubMed  CAS  Google Scholar 

  47. de Mulder M, Umans VA, Stam F, et al. Intensive management of hyperglycaemia in acute coronary syndromes. Study design and rationale of the BIOMArCS 2 glucose trial. Diabet Med. 2011;28:1168–75.

    Article  PubMed  Google Scholar 

  48. Nerenberg KA, Goyal A, Xavier D, et al. Piloting a novel algorithm for glucose control in the coronary care unit: the RECREATE (REsearching Coronary REduction by Appropriately Targeting Euglycemia) trial. Diabetes Care. 2012;35:19–24.

    Article  PubMed  CAS  Google Scholar 

  49. IMMEDIATE (Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care) trial. Clinical trials.gov: a service of the US National Institute of Health: Available at http://clinicaltrials.gov/ct2/show/NCT00091507. Accessed February 2012.

  50. Results of the IMMEDIATE (Immediate Myocardial Metabolic Enhancement During Initial Assessment and Treatment in Emergency Care) trial: a double-blind randomized controlled trial of intravenous glucose, insulin, and potassium (GIK) for acute coronary syndromes in emergency medical services. Joint American College of Cardiology/Journal of the American Medical Association Late-Breaking Clinical Trials. The American College of Cardiology’s (ACC’s) 61st Annual Scientific Session & Expo. Available at http://accscientificsession.cardiosource.org/ACC12/Education/Late-Breakers.aspx. Accessed February 2012.

  51. Fuster V, Farkouh ME. Acute coronary syndromes and diabetes mellitus: a winning ticket for prasugrel. Circulation. 2008;118:1607–8.

    Article  PubMed  Google Scholar 

  52. Lewis Jr HD, Davis JW, Archibald DG, et al. Protective effects of aspirin against acute myocardial infarction and death in men with unstable angina: results of a Veterans Administration Cooperative Study. N Engl J Med. 1983;309:396–403.

    Article  PubMed  Google Scholar 

  53. [No authors listed]. ISIS-2 (Second International Study of Infarct Survival) collaborative group. Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. Lancet. 1988;2:349–360.

    Google Scholar 

  54. Yusuf S, Zhao F, Mehta SR, Clopidogrel in Unstable Angina to Prevent Recurrent Events Trial Investigators, et al. Effects of clopidogrel in addition to aspirin in patients with acute coronary syndromes without ST-segment elevation. N Engl J Med. 2001;345:494–502.

    Article  PubMed  CAS  Google Scholar 

  55. Mehta SR, Yusuf S, Peters RJ, et al. Effects of pretreatment with clopidogrel and aspirin followed by long-term therapy in patients undergoing percutaneous coronary intervention: the PCI-CURE study. Lancet. 2001;358:527–33.

    Article  PubMed  CAS  Google Scholar 

  56. Chen ZM, Jiang LX, Chen YP, et al. Addition of clopidogrel to aspirin in 45,852 patients with acute myocardial infarction: randomised placebo-controlled trial. Lancet. 2005;366:1607–21.

    Article  PubMed  CAS  Google Scholar 

  57. Sabatine MS, Cannon CP, Gibson CM, et al. Addition of clopidogrel to aspirin and fibrinolytic therapy for myocardial infarction with ST-segment elevation. N Engl J Med. 2005;352:1179–89.

    Article  PubMed  CAS  Google Scholar 

  58. Sabatine MS, Cannon CP, Gibson CM, et al. Effect of clopidogrel pretreatment before percutaneous coronary intervention in patients with ST-elevation myocardial infarction treated with fibrinolytics: the PCI-CLARITY study. JAMA. 2005;294:1224–32.

    Article  PubMed  CAS  Google Scholar 

  59. Ferreiro JL, Angiolillo DJ. Diabetes and antiplatelet therapy in acute coronary syndrome. Circulation. 2011;123:798–813.

    Article  PubMed  Google Scholar 

  60. Watala C, Golanski J, Pluta J, et al. Reduced sensitivity of platelets from type 2 diabetic patients to acetylsalicylic acid (aspirin)-its relation to metabolic control. Thromb Res. 2004;113:101–13.

    Article  PubMed  CAS  Google Scholar 

  61. Angiolillo DJ, Bernardo E, Capodanno D, et al. Impact of chronic kidney disease on platelet function profiles in diabetes mellitus patients with coronary artery disease taking dual antiplatelet therapy. J Am Coll Cardiol. 2010;55:1139–46.

    Article  PubMed  CAS  Google Scholar 

  62. Spectre G, Arnetz L, Östenson CG, et al. Twice daily dosing of aspirin improves platelet inhibition in whole blood in patients with type 2 diabetes mellitus and micro- or macrovascular complications. Thromb Haemost. 2011;106:491–9.

    Article  PubMed  Google Scholar 

  63. Smith JP, Haddad EV, Taylor MB, et al. Suboptimal inhibition of platelet cyclooxygenase-1 by aspirin in metabolic syndrome. Hypertension. 2012;59:719–25. Epub 2012 Feb 6.

    Article  PubMed  CAS  Google Scholar 

  64. Mehta SR, Bassand JP, Chrolavicius S, et al. Dose comparisons of clopidogrel and aspirin in acute coronary syndromes. N Engl J Med. 2010;363:930–42.

    Article  PubMed  Google Scholar 

  65. Mehta SR, Tanguay JF, Eikelboom JW, et al. Double-dose versus standard-dose clopidogrel and high-dose versus low-dose aspirin in individuals undergoing percutaneous coronary intervention for acute coronary syndromes (CURRENT-OASIS 7): a randomised factorial trial. Lancet. 2010;376:1233–43.

    Article  PubMed  CAS  Google Scholar 

  66. Wiviott SD, Braunwald E, McCabe CH, et al. Prasugrel versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2007;357:2001–15.

    Article  PubMed  CAS  Google Scholar 

  67. •• Wiviott SD, Braunwald E, Angiolillo DJ, et al. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel–thrombolysis in myocardial infarction 38. Circulation. 2008;118:1626–36. Demonstrated greater net clinical benefit for prasugrel usage in diabetic patients compared to nondiabetic patients in ACS.

    Article  PubMed  CAS  Google Scholar 

  68. Angiolillo DJ, Badimon JJ, Saucedo JF, et al. A pharmacodynamic comparison of prasugrel vs. high-dose clopidogrel in patients with type 2 diabetes mellitus and coronary artery disease: results of the Optimizing anti-Platelet Therapy In diabetes MellitUS (OPTIMUS)-3 trial. Eur Heart J. 2011;32:838–46.

    Article  PubMed  CAS  Google Scholar 

  69. Chin CT, Roe MT, Fox KA, et al. Study design and rationale of a comparison of prasugrel and clopidogrel in medically managed patients with unstable angina/non-ST-segment elevation myocardial infarction: the TaRgeted platelet Inhibition to cLarify the Optimal strateGy to medicallY manage Acute Coronary Syndromes (TRILOGY ACS) trial. Am Heart J. 2010;160:16.e1–22.e1.

    Article  Google Scholar 

  70. Wallentin L, Becker RC, Budaj A, et al. Ticagrelor versus clopidogrel in patients with acute coronary syndromes. N Engl J Med. 2009;361:1045–57.

    Article  PubMed  CAS  Google Scholar 

  71. •• James S, Angiolillo DJ, Cornel JH, et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J. 2010;31:3006–16. Provided evidence that patients with worse glycemic control preferentially benefit from increased platelet inhibition with ticagrelor compared to controlled diabetics.

    Article  PubMed  CAS  Google Scholar 

  72. Anderson JL, Adams CD, Antman EM, et al. 2011 ACCF/AHA focused update incorporated into the ACC/AHA 2007 guidelines for the management of patients with unstable angina/non-ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation. 2011;123:e426–579.

    Article  PubMed  Google Scholar 

  73. Marso SP, Lincoff AM, Ellis SG, et al. Optimizing the percutaneous interventional outcomes for patients with diabetes mellitus: results of the EPISTENT (evaluation of platelet IIb/IIIa inhibitor for stenting trial) diabetic substudy. Circulation. 1999;100:2477–84.

    PubMed  CAS  Google Scholar 

  74. Bhatt DL, Marso SP, Lincoff AM, et al. Abciximab reduces mortality in diabetics following percutaneous coronary intervention. J Am Coll Cardiol. 2000;35:922–8.

    Article  PubMed  CAS  Google Scholar 

  75. Kastrati A, Mehilli J, Neumann FJ, Dotzer F, et al. Abciximab in patients with acute coronary syndromes undergoing percutaneous coronary intervention after clopidogrel pretreatment: the ISAR-REACT 2 randomized trial. JAMA. 2006;295:1531–8.

    Article  PubMed  CAS  Google Scholar 

  76. De Luca G, Navarese E, Marino P. Risk profile and benefits from GpIIb-IIIa inhibitors among patients with ST-segment elevation myocardial infarction treated with primary angioplasty: a meta-regression analysis of randomized trials. Eur Heart J. 2009;30:2705–13.

    Article  PubMed  Google Scholar 

  77. Théroux P, Ouimet H, McCans J, et al. Aspirin, heparin, or both to treat acute unstable angina. N Engl J Med. 1988;319:1105–11.

    Article  PubMed  Google Scholar 

  78. Mahaffey KW, Cohen M, Garg J, Antman E, et al. High-risk patients with acute coronary syndromes treated with low-molecular-weight or unfractionated heparin: outcomes at 6 months and 1 year in the SYNERGY trial. JAMA. 2005;294:2594–600.

    Article  PubMed  CAS  Google Scholar 

  79. Blazing MA, De Lemos JA, Dyke CK, et al. The A-to-Z trial: methods and rationale for a single trial investigating combined use of low-molecular-weight heparin with the glycoprotein IIb/IIIa inhibitor tirofiban and defining the efficacy of early aggressive simvastatin therapy. Am Heart J. 2001;142:211–7.

    Article  PubMed  CAS  Google Scholar 

  80. Stone GW, McLaurin BT, Cox DA, et al. Bivalirudin for patients with acute coronary syndromes. N Engl J Med. 2006;355:2203–16.

    Article  PubMed  CAS  Google Scholar 

  81. Feit F, Manoukian SV, Ebrahimi R, et al. Safety and efficacy of bivalirudin monotherapy in patients with diabetes mellitus and acute coronary syndromes: a report from the ACUITY (Acute Catheterization and Urgent Intervention Triage Strategy) trial. J Am Coll Cardiol. 2008;51:1645–52.

    Article  PubMed  CAS  Google Scholar 

  82. Stone GW, Witzenbichler B, Guagliumi G, et al. Bivalirudin during primary PCI in acute myocardial infarction. N Engl J Med. 2008;358:2218–30.

    Article  PubMed  CAS  Google Scholar 

  83. Witzenbichler B, Mehran R, Guagliumi G, et al. Impact of diabetes mellitus on the safety and effectiveness of bivalirudin in patients with acute myocardial infarction undergoing primary angioplasty: analysis from the HORIZONS-AMI (Harmonizing Outcomes with RevasculariZatiON and Stents in Acute Myocardial Infarction) trial. JACC Cardiovasc Interv. 2011;4:760–8.

    Article  PubMed  Google Scholar 

  84. Kastrati A, Neumann FJ, Schulz S, et al. Abciximab and heparin versus bivalirudin for non-ST-elevation myocardial infarction. N Engl J Med. 2011;36:1980–9.

    Article  Google Scholar 

  85. [No authors listed]. Indications for fibrinolytic therapy in suspected acute myocardial infarction: collaborative overview of early mortality and major morbidity results from all randomised trials of more than 1,000 patients. Fibrinolytic Therapy Trialists’ (FTT) collaborative group. Lancet. 1994;343:311–322.

  86. Timmer JR, Ottervanger JP, de Boer MJ, et al. Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the primary coronary angioplasty vs. thrombolysis-2 trial. Arch Intern Med. 2007;167:1353–9.

    Article  PubMed  Google Scholar 

  87. Bonnefoy E, Steg PG, Chabaud S, et al. Is primary angioplasty more effective than prehospital fibrinolysis in diabetics with acute myocardial infarction? data from the CAPTIM randomized clinical trial. Eur Heart J. 2005;26:1712–8.

    Article  PubMed  Google Scholar 

  88. Bonnefoy E, Lapostolle F, Leizorovicz A, et al. Primary angioplasty versus prehospital fibrinolysis in acute myocardial infarction: a randomised study. Lancet. 2002;360:825–9.

    Article  PubMed  Google Scholar 

  89. Roffi M, Eberli FR. Diabetes and acute coronary syndromes. Best Pract Res Clin Endocrinol Metabol. 2009;23:305–16.

    Article  CAS  Google Scholar 

  90. Witzenbichler B, Wöhrle J, Guagliumi G, et al. Paclitaxel-eluting stents compared with bare metal stents in diabetic patients with acute myocardial infarction: the Harmonizing Outcomes with Revascularization and Stents in Acute Myocardial Infarction (HORIZONS-AMI) trial. Circ Cardiovasc Interv. 2011;4:130–8.

    Article  PubMed  CAS  Google Scholar 

  91. Stettler C, Allemann S, Wandel S, et al. Drug eluting and bare metal stents in people with and without diabetes: collaborative network meta-analysis. BMJ. 2008;337:a1331.

    Article  PubMed  Google Scholar 

  92. Wallentin L, Lagerqvist B, Husted S, et al. Outcome at 1 year after an invasive compared with a non-invasive strategy in unstable coronary-artery disease: the FRISC II invasive randomised trial. FRISC II investigators. Fast revascularisation during instability in coronary artery disease. Lancet. 2000;356:9–16.

    Article  PubMed  CAS  Google Scholar 

  93. Cannon CP, Weintraub WS, Demopoulos LA, et al. Comparison of early invasive and conservative strategies in patients with unstable coronary syndromes treated with the glycoprotein IIb/IIIa inhibitor tirofiban. N Engl J Med. 2001;344:1879–87.

    Article  PubMed  CAS  Google Scholar 

  94. Sedlis SP, Morrison DA, Lorin JD, et al. Percutaneous coronary intervention versus coronary bypass graft surgery for diabetic patients with unstable angina and risk factors for adverse outcomes with bypass: outcome of diabetic patients in the AWESOME randomized trial and registry. J Am Coll Cardiol. 2002;40:1555–66.

    Article  PubMed  Google Scholar 

  95. Bansilal S, Farkouh ME, Hueb W, et al. The FREEDOM Trial: A snapshot at randomization. Circulation 2011, 124: A11903 American Heart Association’s Scientific Sessions 2011. Orlando, FL; November 12–16, 2011.

Download references

Disclosure

No potential conflicts of interest relevant to this article were reported.

Author information

Authors and Affiliations

  1. Zena and Michael A. Weiner Cardiovascular Institute, Mount Sinai School of Medicine, New York, NY, 10029, USA

    Sanjum S. Sethi & Michael E. Farkouh

  2. Department of Medicine, Englewood Hospital and Medical Center, Englewood, NJ, 07631, USA

    Elias G. Akl

Authors
  1. Sanjum S. Sethi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Elias G. Akl
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Michael E. Farkouh
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michael E. Farkouh.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sethi, S.S., Akl, E.G. & Farkouh, M.E. Diabetes Mellitus and Acute Coronary Syndrome: Lessons From Randomized Clinical Trials. Curr Diab Rep 12, 294–304 (2012). https://doi.org/10.1007/s11892-012-0272-9

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11892-012-0272-9

Keywords

Search

Navigation