Aims To investigate the impact of an early coronary revascularization (<24 h) compared with initial conservative strategy on clinical outcomes in diabetic patients with non-ST-segment elevation acute coronary syndrome (NSTE-ACS) who are in stable condition at hospital admission. Methods and results The International Survey of Acute Coronary Syndromes database was queried for a sample of diabetic and nondiabetic patients with diagnosis of NSTE-ACS. Patients with cardiac arrest, haemodynamic instability, and serious ventricular arrhythmias were excluded. The characteristics between groups were adjusted using logistic regression and inverse probability of treatment weighting models. Primary outcome measure was all-cause 30-day mortality. Risk ratios (RRs) and odds ratios (ORs) with their 95% confidence intervals (CIs) were employed. Of the 7589 NSTE-ACS patients identified, 2343 were diabetics. The data show a notable reduction in mortality for the elderly (>65 years) undergoing early revascularization compared to those receiving an initial conservative strategy both in the diabetic (3.3% vs. 6.7%; RR: 0.48; 95% CI: 0.28–0.80) and nondiabetic patients (2.7% vs. 4.7%: RR: 0.57; 95% CI: 0.36–0.90). In multivariate analyses, diabetes was a strong independent predictor of mortality in the elderly (OR: 1.43; 95% CI: 1.03–1.99), but not in the younger patients (OR: 1.04; 95% CI: 0.53–2.06). Conclusion Early coronary revascularization does not lead to any survival advantage within 30 days from admission in young NSTE-ACS patients who present to hospital in stable conditions with and without diabetes. An early invasive management strategy may be best reserved for the elderly. Factors beyond revascularization are of considerable importance for outcome in elderly diabetic subjects with NSTE-ACS. Clinical trial number ClinicalTrials.gov: NCT01218776.

中文翻译：

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非 ST 段抬高型急性冠脉综合征“稳定”患者的早期冠状动脉血运重建：糖尿病和年龄的作用


目的 探讨早期冠状动脉血运重建 （<24 h） 与初始保守策略相比，对入院时病情稳定的非 ST 段抬高型急性冠脉综合征 （NSTE-ACS） 糖尿病患者临床结局的影响。方法和结果 查询了急性冠脉综合征国际调查数据库，以获取诊断为 NSTE-ACS 的糖尿病和非糖尿病患者的样本。排除心脏骤停、血流动力学不稳定和严重室性心律失常的患者。使用 logistic 回归和治疗加权模型的逆概率调整组间特征。主要结局指标是全因 30 天死亡率。采用风险比 （RRs） 和比值比 （ORs） 及其 95% 置信区间 （CIs）。在确定的 7589 名 NSTE-ACS 患者中，有 2343 名是糖尿病患者。数据显示，与接受初始保守治疗相比，接受早期血运重建的老年人 （x3E65 岁） 的死亡率显著降低，无论是在糖尿病患者中 （3.3% 对 6.7%;RR： 0.48;95% CI：0.28-0.80）和非糖尿病患者（2.7% vs. 4.7%：RR：0.57;95% CI：0.36-0.90）。在多变量分析中，糖尿病是老年人死亡率的强独立预测因子 （OR： 1.43;95% CI： 1.03–1.99），但在年轻患者中则不是 （OR： 1.04;95% CI： 0.53–2.06）。结论 早期冠状动脉血运重建不会为病情稳定的年轻 NSTE-ACS 患者在入院后 30 天内带来任何生存优势，无论是否患有糖尿病。早期侵入性管理策略可能最好留给老年人。 血运重建以外的因素对患有 NSTE-ACS 的老年糖尿病受试者的结局具有相当重要的意义。临床试验编号 ClinicalTrials.gov：NCT01218776。