Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndrome

António, N

Freitas, M

Gonçalves, F

Gonçalves, L

Lourenço, C

Monteiro, P

Providência, LA

Saraiva, F

Soares, F

Arquivos Brasileiros de Endocrinologia & Metabologia

Name not available

Impacto da insulinoterapia prévia no prognóstico dos pacientes diabéticos com síndromes coronárias agudas

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease

António,Natália

Soares,Francisco

Lourenço,Carolina

Saraiva,Fátima

Gonçalves,Francisco

Monteiro,Pedro

Gonçalves,Lino

Freitas,Mário

Providência,Luís A.

LAReferencia - Red Federada de Repositorios Institucionales de Publicaciones Científicas Latinoamericanas

Impact of previous insulin therapy on the prognosis of diabetic patients with acute coronary syndromes

OBJECTIVE: To determine whether previous insulin treatment independently influences subsequent outcomes in diabetic patients with ACS (acute coronary syndromes). SUBJECTS AND METHODS: 375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) - previous insulin and Group B (n = 306) - without previous insulin. Predictors of 1-year mortality and major adverse cardiac events (MACE) were analyzed by Cox regression analysis. RESULTS: Group A had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs. 3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol. There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%, p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin treatment was neither an independent predictor of 1-year mortality nor of MACE. CONCLUSION: Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes to those without insulin. Insulin may protect diabetics from the expected poor adverse outcome of an advanced atherosclerotic disease.</jats:p

Natália António

Francisco Soares

Carolina Lourenço

Fátima Saraiva

Francisco Gonçalves

Pedro Monteiro

Lino Gonçalves

Mário Freitas

Luís A. Providência

Crossref

Repositório Institucional dos Hospitais da Universidade de Coimbra

Objective: To determine whether previous insulin treatment independently influences subsequent
outcomes in diabetic patients with ACS (acute coronary syndromes). Subjects and methods:
375 diabetic patients with ACS, divided in 2 groups: Group A (n = 69) – previous insulin
and Group B (n = 306) – without previous insulin. Predictors of 1-year mortality and major
adverse cardiac events (MACE) were analyzed by Cox regression analysis. Results: Group A
had more previous stroke (17.4% vs. 9.2%, p = 0.047) and peripheral artery disease (13.0% vs.
3.6%, p = 0.005). They had significantly higher admission glycemia and lower LDL cholesterol.
There were no significant differences in the type of ACS, in 1-year mortality (18.2% vs. 10.4%,
p = 0.103) or MACE (32.1% vs. 23.0%, p = 0.146) between groups. In multivariate analysis, insulin
treatment was neither an independent predictor of 1-year mortality nor of MACE. Conclusion:
Despite the more advanced atherosclerotic disease, diabetics under insulin had similar outcomes
to those without insulin. Insulin may protect diabetics from the expected poor adverse
outcome of an advanced atherosclerotic disease.Objectivo: Avaliar se a insulinoterapia prévia influencia de forma independente o prognóstico de
diabéticos após uma síndrome coronária aguda (SCA). Sujeitos e métodos: 375 doentes diabéticos
com SCA, divididos em 2 grupos: Grupo A (n = 69) – sob insulinoterapia prévia e Grupo B (n =
306) – sem insulinoterapia prévia. Os preditores de mortalidade a um ano e de eventos cardíacos
adversos maiores (MACE) foram determinados pela regressão de Cox. Resultados: Verificou-se
maior proporção de acidente vascular cerebral prévio (17,4% vs. 9,2%, p = 0,047) e doença arterial
periférica (13,0% vs. 3,6%, p = 0,005) no Grupo A. Esses doentes apresentaram glicemia na
admissão significativamente mais elevada e LDL inferior. Não houve diferenças estatisticamente
significativas no tipo de SCA, na mortalidade (18,2% vs. 10,4%, p = 0,103) e MACE (32,1% vs.
23,0%, p = 0,146) em um ano entre os 2 grupos. Na análise multivariada, a insulinoterapia prévia
não foi preditor independente nem de mortalidade, nem de MACE em 1 ano. Conclusão: Apesar
da doença aterosclerótica mais avançada, os diabéticos previamente insulino-tratados têm um
prognóstico semelhante aos não insulino-tratados. A insulinoterapia crônica poderá proteger os
diabéticos da evolução desfavorável própria da doença aterosclerótica avançada

António, Natália

Soares, Francisco

Lourenço, Carolina

Saraiva, Fátima

Gonçalves, Francisco

Monteiro, Pedro

Gonçalves, Lino

Freitas, Mário

Providência, Luís A.

Estudo Geral

CHUC Institutional Repository

http://www.scielo.br/scielo.php?script=sci_arttext&pid=S0004-27302010000700005

Impacto da insulinoterapia prévia no prognóstico dos pacientes diabéticos com síndromes coronárias agudas

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