Early Invasive Strategy and In-Hospital Survival Among Diabetics With Non-St-Elevation Acute Coronary Syndromes: A Contemporary National Insight

Background--there are limited data on the merits of an early invasive strategy in diabetics with non-st-elevation acute coronary syndrome,with unclear influence of this strategy on survival. the aim of this study was to evaluate the in-hospital survival of diabetics with non-st-elevation acute coronary syndrome treated with an early invasive strategy compared with an initial conservative strategy. methods and results--the national inpatient sample database,years 2012-2013,was queried for diabetics with a primary diagnosis of non-st-elevation acute coronary syndrome defined as either non-st-elevation myocardial infarction or unstable angina (unstable angina). an early invasive strategy was defined as coronary angiography ±revascularization within 48 hours of admission. propensity scores were used to assemble a cohort managed with either an early invasive or initial conservative strategy balanced on >50 baseline characteristics and hospital presentations. incidence of in-hospital mortality was compared in both groups. in a cohort of 363 500 diabetics with non-st-elevation acute coronary syndrome,164 740 (45.3%) were treated with an early invasive strategy. propensity scoring matched 21 681 diabetics in both arms. incidence of in-hospital mortality was lower with an early invasive strategy in both the unadjusted (2.0% vs 4.8%; odds ratio [or],0.41; 95% ci,0.39-0.42; p<0.0001) and propensitymatched models (2.2% vs 3.8%; or,0.57; 95% ci,0.50-0.63; p<0.0001). the benefit was observed across various subgroups,except for patients with unstable angina (pinteraction=0.02). conclusions--an early invasive strategy may be associated with a lower incidence of in-hospital mortality in patients with diabetes. the benefit of this strategy appears to be superior in patients presenting with non-st-elevation myocardial infarction compared with unstable angina. © 2017 the authors.