Suspected Acute Coronary Syndrome Patients With Diabetes and Normal Troponin-I Levels Are at Risk for Early and Late Death

Clinicians use a variety of methods (1,2) to risk stratify patients with acute coronary syndromes (ACSs). Based on elevated risk, patients are often triaged to an aggressive strategy, including early angiography (3,4) and upstream use of intravenous glycoprotein IIb/IIIa inhibitors (5–7). The current American College of Cardiology (ACC)/American Heart Association (AHA) Guidelines for the Management of Patients with Unstable Angina and Non-ST-segment Elevation Myocardial Infarction do not recognize diabetes as a high-risk ACS indicator. Therefore, we sought to clarify the relative risk of diabetes in early and late death in suspected ACS patients.In this study, a prospective registry of consecutive ACS patients with and without diabetes ( n = 864) was used. ACS was diagnosed as either myocardial infarction (8) or unstable angina (9) using standard definitions. Patients with ST-segment elevation myocardial infarction were excluded. All potential unstable angina patients who had a diagnostic angiographic, nuclear, or echocardiographic stress test that excluded obstructive coronary disease or who had an additional diagnostic study confirming an alternative explanation for presentation were excluded. Diabetes was defined by reported history or new antidiabetic therapy initiated during …