Characteristics and six-month outcomes in a cohort of 8288 diabetic and non-diabetic patients with previous history of acute coronary syndrome or stroke: the French PREVENIR 3 survey
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Abstract
To evaluate the cardiovascular prognosis of 1845 Diabetic Patients (DP) and 6443 Non-Diabetic
Patients (NDP) in secondary prevention.
Patients were recruited prospectively if they had had a previous history of ischemic
stroke or acute coronary syndrome (ACS) i.e. Myocardial Infarction (MI) or Unstable
Angina (UA) within a period of five years preceding inclusion. For each patient, the
number of hospitalizations and vital status were recorded each month over a 6-month
period (mean follow-up: 4.8 months).
306 patients (9.5/100--person years; 95% CI, 8.5 to 10.6) had undergone at least one
subsequent event (hospitalization for ACS, ischemic stroke, or cardiovascular death).
A majority of these events were non-fatal ACS (n=248). The cumulative incidence rate
of subsequent events was higher in DP: 12.6/100- person years (10.0 to 15.2) than
in NDP: 8.6/100--person years (7.5 to 9.8). DP were significantly at higher risk of
subsequent cardiovascular events (OR: 1.34; P=0.025) after adjustment for confounding
factors. 93% of coronary DP and NDP underwent a recurrent event affecting the same
location. When the index episode was a stroke, 71% of DP had a subsequent stroke vs.
47% of NDP.
in secondary prevention, the risk of mortality and subsequent vascular events is independently
higher in French DP than in NDP. The locations affected by each type of subsequent
cardiovascular event seemed correlated to the baseline diagnosis, whatever the diabetic
status, even when the frequency of subsequent strokes increased (not significantly)
in DP when compared to NDP.