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

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

doi:10.1177/1479164117735493

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

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

Circulatory Health

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

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.

Original language	English
Pages (from-to)	14-23
Number of pages	10
Journal	Diabetes and Vascular Disease Research
Volume	15
Issue number	1
DOIs	https://doi.org/10.1177/1479164117735493
Publication status	Published - 1 Jan 2018

Keywords

Acute coronary syndromes
diabetes mellitus
mortality

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Savonitto, S., Morici, N., Nozza, A., Cosentino, F., Perrone Filardi, P., Murena, E., Morocutti, G., Ferri, M., Cavallini, C., Eijkemans, M. J., Stähli, B. E., Schrieks, I. C., Toyama, T., Lambers Heerspink, H. J., Malmberg, K., Schwartz, G. G., Lincoff, A. M., Ryden, L., Tardif, J.-C., & Grobbee, D. E. (2018). Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes. Diabetes and Vascular Disease Research, 15(1), 14-23. https://doi.org/10.1177/1479164117735493

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abstract = "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.",

keywords = "Acute coronary syndromes, diabetes mellitus, mortality",

author = "Stefano Savonitto and Nuccia Morici and Anna Nozza and Francesco Cosentino and {Perrone Filardi}, Pasquale and Ernesto Murena and Giorgio Morocutti and Marco Ferri and Claudio Cavallini and Eijkemans, {Marinus Jc} and St{\"a}hli, {Barbara E} and Schrieks, {Ilse C} and Tadashi Toyama and {Lambers Heerspink}, H.J. and Klas Malmberg and Schwartz, {Gregory G.} and Lincoff, {A. Michael} and Lars Ryden and Jean-Claude Tardif and Grobbee, {Diederick E}",

note = "Publisher Copyright: {\textcopyright} 2017, {\textcopyright} The Author(s) 2017.",

year = "2018",

month = jan,

day = "1",

doi = "10.1177/1479164117735493",

language = "English",

volume = "15",

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Savonitto, S, Morici, N, Nozza, A, Cosentino, F, Perrone Filardi, P, Murena, E, Morocutti, G, Ferri, M, Cavallini, C, Eijkemans, MJ, Stähli, BE, Schrieks, IC, Toyama, T, Lambers Heerspink, HJ, Malmberg, K, Schwartz, GG, Lincoff, AM, Ryden, L, Tardif, J-C & Grobbee, DE 2018, 'Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes', Diabetes and Vascular Disease Research, vol. 15, no. 1, pp. 14-23. https://doi.org/10.1177/1479164117735493

TY - JOUR

T1 - Predictors of mortality in hospital survivors with type 2 diabetes mellitus and acute coronary syndromes

AU - Savonitto, Stefano

AU - Morici, Nuccia

AU - Nozza, Anna

AU - Cosentino, Francesco

AU - Perrone Filardi, Pasquale

AU - Murena, Ernesto

AU - Morocutti, Giorgio

AU - Ferri, Marco

AU - Cavallini, Claudio

AU - Eijkemans, Marinus Jc

AU - Stähli, Barbara E

AU - Schrieks, Ilse C

AU - Toyama, Tadashi

AU - Lambers Heerspink, H.J.

AU - Malmberg, Klas

AU - Schwartz, Gregory G.

AU - Lincoff, A. Michael

AU - Ryden, Lars

AU - Tardif, Jean-Claude

AU - Grobbee, Diederick E

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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.

AB - 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.

KW - Acute coronary syndromes

KW - diabetes mellitus

KW - mortality

U2 - 10.1177/1479164117735493

DO - 10.1177/1479164117735493

M3 - Article

C2 - 29052439

SN - 1479-1641

VL - 15

SP - 14

EP - 23

JO - Diabetes and Vascular Disease Research

JF - Diabetes and Vascular Disease Research

IS - 1

ER -

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

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