Acute coronary syndrome and diabetes mellitus from the perspective of invasive cardiologist

Authors: doc. MUDr. Martin Studenčan, PhD.
Authors‘ workplace: Kardiocentrum FNsP J. A. Reimana, Prešov
Published in: Forum Diab 2015; 4(1): 50-54
Category: Topic


Diabetes mellitus is one of the risk factor for development of acute coronary syndrome (ACS) and significantly affects the prognosis of patients after overcoming ACS. Invasive cardiologist has to take into consideration the presence of diabetes at all stages during management of patients with ACS: Diagnostic phase – might be complicated by modi­fication of symptoms, phase of treatment – diabetes is taken into account in the risk stratification and also and also in strategy of revascularization, and phase of follow up of patient – characterized by worse prognosis, higher risk of ACS recurrence and emphasis on tight control of diabetes.

Key words:
acute coronary syndrome – antiplatelet therapy- coronary revascularization – diabetes mellitus – risk factors – stents


1. Studencan M, Kovar F, Hricak V et al. Two years survival of STEMI patients in Slovakia. An analysis of the SLOVak registry of Acute Coronary Syndromes (SLOVAKS). Cor et Vasa 2014; 56(4): 297–303.

2. Kovář F, Studenčan M, Hricák V et al. Súčasný stav manažmentu pacientov s NSTE-AKS v Slovenskej republike. Analýza výsledkov registra SLOVAKS-2 z roku 2011. Cardiology Letters 2014; 23(2): 115–125.

3. Malmberg K, Ryden L, Efendic S et al. Randomized trial of insulin-glucose infusion followed by subcutaneous insulin treatment in diabetic patients with acute myocardial infarction (DIGAMI study): effects on mortality at 1 year. J Am Coll Cardiol 1995; 26(1): 57–65.

4. Diaz R, Goyal A, Mehta SR et al. Glucose-insulin-potassium therapy in patients with ST-segment elevation myocardial infarction. JAMA 2007; 298(20): 2399–2405.

5. Finfer S, Chittock DR, Su SY et al. Intensive versus conventional glucose control in critically ill patients. N Engl J Med 2009; 360(13): 1283–1297.

6. Steg PG, James SK, Atar D et al. ESC Guidelines for the management of acute myocardial infarction in patients presenting with ST-segment elevation: The Task Force on the management of ST-segment elevation acute myocardial infarction of the European Society of Cardiology (ESC). Eur Heart J 2012; 33(20): 2569–2619.

7. Windecker S, Kolh P, Alfonso F et al. 2014 ESC/EACTS Guidelines on myocardial revascularization: The Task Force on Myocardial Revascularization of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS) Developed with the special contribution of the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention 2014. Dostupné z DOI: .

8. O‘Donoghue ML, Vaidya A, Afsal R et al. An invasive or conservative strategy in patients with diabetes mellitus and non-ST-segment elevation acute coronary syndromes: a collaborative meta-analysis of randomized trials. J Am Coll Cardiol Jul 10 2012; 60(2): 106–111.

9. Hamm CW, Bassand JP, Agewall S et al. ESC Guidelines for the management of acute coronary syndromes in patients presenting without persistent ST-segment elevation: The Task Force for the management of acute coronary syndromes (ACS) in patients presenting without persistent ST-segment elevation of the European Society of Cardiology (ESC). European heart journal 2011; 32(23): 2999–3054.

10. Timmer JR, Ottervanger JP, de Boer MJ et al. Primary percutaneous coronary intervention compared with fibrinolysis for myocardial infarction in diabetes mellitus: results from the Primary Coronary Angioplasty vs Thrombolysis-2 trial. Arch Intern Med 2007; 167(13): 1353–1359.

11. Studenčan M, Hricák V, Kovář F et al. Aktuálne trendy v starostlivosti o pacientov so STEMI na Slovensku. Analýza výsledkov registra SLOVAKS-2 z roku 2011. Cardiology Letters 2013; 22(2): 115–124.

12. Stettler C, Wandel S, Allemann S et al. Outcomes associated with drug-eluting and bare-metal stents: a collaborative network meta-analysis. Lancet 2007; 370(9591): 937–948.

13. Kirtane AJ, Gupta A, Iyengar S et al. Safety and efficacy of drug-eluting and bare metal stents: comprehensive meta-analysis of randomized trials and observational studies. Circulation 2009; 119(25): 3198–3206.

14. Bangalore S, Kumar S, Fusaro M et al. Short- and long-term outcomes with drug-eluting and bare-metal coronary stents: a mixed-treatment comparison analysis of 117 762 patient-years of follow-up from randomized trials. Circulation. 2012; 125(23): 2873–2891.

15. Cannon CP, Harrington RA, James S et al. Comparison of ticagrelor with clopidogrel in patients with a planned invasive strategy for acute coronary syndromes (PLATO): a randomised double-blind study. Lancet 2010; 375(9711): 283–293.

16. Montalescot G, Wiviott SD, Braunwald E et al. Prasugrel compared with clopidogrel in patients undergoing percutaneous coronary intervention for ST-elevation myocardial infarction (TRITON-TIMI 38): double-blind, randomised controlled trial. Lancet 2009; 373(9665): 723–731.

17. Wiviott SD, Braunwald E, Angiolillo DJ et al. Greater clinical benefit of more intensive oral antiplatelet therapy with prasugrel in patients with diabetes mellitus in the trial to assess improvement in therapeutic outcomes by optimizing platelet inhibition with prasugrel-Thrombolysis in Myocardial Infarction 38. Circulation 2008; 118(16): 1626–1636.

18. James S, Angiolillo DJ, Cornel JH et al. Ticagrelor vs. clopidogrel in patients with acute coronary syndromes and diabetes: a substudy from the PLATelet inhibition and patient Outcomes (PLATO) trial. Eur Heart J 2010; 31(24): 3006–3016.

Diabetology Endocrinology Internal medicine
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