Title:Comparison of Clinical Outcomes between Newly Diagnosed and Pre-Existing Diabetes Mellitus Patients after Acute Coronary Syndrome
Volume: 24
Issue: 1
Author(s): Wei-Chieh Lee, Huang-Chung Chen, Chih-Yuan Fang, Yi-Hsuan Tsai, Yun-Yu Hsieh, Tien-Yu Chen, Yen-Nan Fang, Po-Jui Wu, Hsiu-Yu Fang*Ping-Yen Liu*
Affiliation:
- Division of Cardiology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan
- Division of Cardiology, Department of Internal Medicine, Jen-Ai Hospital, Taichung, Taiwan
- Institute of Clinical Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Division of Cardiology, Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
Keywords:
Acute coronary syndrome, diabetes mellitus, newly diagnosed, pre-existing, HbA1c.
Abstract:
Aims: This study aimed to evaluate clinical outcomes, including recurrent acute coronary
syndrome (ACS) and mortality, in ACS patients with varying HbA1c levels, addressing the controversy
over optimal targets in those with newly diagnosed and pre-existing diabetes mellitus (DM).
Methods: From January 2005 to December 2019, a total of 33,990 patients were identified with ACS
in the Chang Gung Research Database based on their medical history. After excluding patients without
DM and baseline or subsequent HbA1C data, a cohort of 11,870 DM patients was divided into
two groups: one consisting of 6,089 patients with newly diagnosed DM and the other comprising
5,781 patients with pre-existing DM.
Results: During the three-year follow-up, the pre-existing DM group experienced worse clinical outcomes,
such as increased rates of re-ACS, major bleeding, cardiovascular (CV) events, and all-cause
mortality. Optimal HbA1c levels for mitigating re-ACS and/or CV mortality and all-cause mortality
appeared to differ between the two DM cohorts. Re-ACS and CV mortality reached their highest at an
HbA1c of 6.8% for all DM patients, 6.6% for newly diagnosed, and 6.7% for pre-existing cases. The
greatest all-cause mortality risk was at an HbA1c of 7.4% for all DM patients, 7.0% in newly diagnosed,
and 8.2% in pre-existing patients.
Conclusion: Upon comparing newly diagnosed DM patients with those with pre-existing DM, a
poorer prognosis was observed in the latter group, attributed to older age and a higher burden of
comorbidities. Throughout the follow-up period, maintaining consistently low HbA1c levels did not
reduce the incidence of re-ACS nor enhance survival rates.
