Skip to main content

Advertisement

SpringerLink
Log in

Diabetes mellitus, frailty and prognosis in very elderly patients with acute coronary syndromes

  • Original Article
  • Published:
Aging Clinical and Experimental Research Aims and scope Submit manuscript

Abstract

Background

The magnitude of the association between diabetes (DM) and outcomes in elderly patients with acute coronary syndromes (ACS) is controversial. No study assessed the prognostic impact of DM according to frailty status in these patients.

Methods

The LONGEVO-SCA registry included unselected ACS patients aged ≥ 80 years. Frailty was assessed by the FRAIL scale. We evaluated the impact of previous known DM on the incidence of death or readmission at 6 months according to status frailty by the Cox regression method.

Results

A total of 532 patients were included. Mean age was 84.3 years, and 212 patients (39.8%) had previous DM diagnosis. Patients with DM had more comorbidities and higher prevalence of frailty (33% vs 21.9%, p = 0.002). The incidence of death or readmission at 6 months was higher in patients with DM (HR 1.52, 95% CI 1.12–2.05, p 0.007), but after adjusting for potential confounders this association was not significant. The association between DM and outcomes was not significant in robust patients, but it was especially significant in patients with frailty [HR 1.72 (1.05–2.81), p = 0.030, p value for interaction = 0.049].

Conclusions

About 40% of elderly patients with ACS had previous known DM diagnosis. The association between DM and outcomes was different according to frailty status.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Guariguata L, Whiting DR, Hambleton I et al (2014) Global estimates of diabetes prevalence for 2013 and projections for 2035. Diabetes Res Clin Pract 103:137–149. https://doi.org/10.1016/j.diabres.2013.11.002

    Article  CAS  PubMed  Google Scholar 

  2. Degano IR, Elosua R, Marrugat J (2013) Epidemiology of acute coronary syndromes in Spain: estimation of the number of cases and trends from 2005 to 2049. Rev Esp Cardiol 66:472–481. https://doi.org/10.1016/j.rec.2013.01.018

    Article  PubMed  Google Scholar 

  3. Krumholz HM, Gross CP, Peterson ED et al (2003) Is there evidence of implicit exclusion criteria for elderly subjects in randomized trials? Evidence from the GUSTO-1 study. Am Heart J 146:839–847. https://doi.org/10.1016/S0002-8703(03)00408-3

    Article  PubMed  Google Scholar 

  4. Noman A, Balasubramaniam K, Alhous MHA et al (2017) Mortality after percutaneous coronary revascularization: Prior cardiovascular risk factor control and improved outcomes in patients with diabetes mellitus. Catheter Cardiovasc Interv 89:1195–1204. https://doi.org/10.1002/ccd.26882

    Article  PubMed  Google Scholar 

  5. De Servi S, Crimi G, Calabrò P et al (2016) Relationship between diabetes, platelet reactivity, and the SYNTAX score to one-year clinical outcome in patients with non-ST-segment elevation acute coronary syndrome undergoing percutaneous coronary intervention. Eurointervention 12:312–318. https://doi.org/10.4244/EIJV12I3A51

    Article  PubMed  Google Scholar 

  6. Cordero A, López-Palop R, Carrillo P et al (2016) Comparison of long-term mortality for cardiac diseases in patients with versus without diabetes mellitus. Am J Cardiol 117:1088–1094. https://doi.org/10.1016/j.amjcard.2015.12.057

    Article  PubMed  Google Scholar 

  7. Klempfner R, Elis A, Matezky S et al (2015) Temporal trends in management and outcome of diabetic and non-diabetic patients with acute coronary syndrome (ACS): residual risk of long-term mortality persists: insights from the ACS Israeli Survey (ACSIS) 2000–2010. Int J Cardiol 179:546–551. https://doi.org/10.1016/j.ijcard.2014.10.116

    Article  PubMed  Google Scholar 

  8. Donahoe SM, Stewart GC, McCabe CH et al (2007) Diabetes and mortality following acute coronary syndromes. JAMA 298:765–775. https://doi.org/10.1001/jama.298.7.765

    Article  CAS  PubMed  Google Scholar 

  9. Savonitto S, Morici N, Cavallini C et al (2014) One-year mortality in elderly adults with non-ST-elevation acute coronary syndrome: effect of diabetic status and admission hyperglycemia. J Am Geriatr Soc 62:1297–1303. https://doi.org/10.1111/jgs.12900

    Article  PubMed  Google Scholar 

  10. Fu Z, Xue H, Guo J et al (2013) Long-term prognostic impact of cystatin C on acute coronary syndrome octogenarians with diabetes mellitus. Cardiovasc Diabetol 12:157. https://doi.org/10.1186/1475-2840-12-157

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Morley JE (2008) Diabetes, sarcopenia, and frailty. Clin Geriatr Med 24:455–469. https://doi.org/10.1016/j.cger.2008.03.004

    Article  PubMed  Google Scholar 

  12. Sinclair AJ, Abdelhafiz AH, Rodríguez-Mañas L (2017) Frailty and sarcopenia - newly emerging and high impact complications of diabetes. J Diabetes Complicat 31:1465–1473. https://doi.org/10.1016/j.jdiacomp.2017.05.003

    Article  PubMed  Google Scholar 

  13. Ekerstad N, Swahn E, Janzon M et al (2011) Frailty is independently associated with short-term outcomes for elderly patients with non-ST-segment elevation myocardial infarction. Circulation 124:2397–2404. https://doi.org/10.1161/CIRCULATIONAHA.111.025452

    Article  PubMed  Google Scholar 

  14. Núñez J, Ruiz V, Bonanad C et al (2017) Percutaneous coronary intervention and recurrent hospitalizations in elderly patients with non ST-segment acute coronary syndrome: The role of frailty. Int J Cardiol 228:456–458. https://doi.org/10.1016/j.ijcard.2016.11.151

    Article  PubMed  Google Scholar 

  15. Blanco S, Ferrières J, Bongard V et al (2017) Prognosis impact of frailty assessed by the Edmonton frail scale in the setting of acute coronary syndrome in the elderly. Can J Cardiol 33:933–939. https://doi.org/10.1016/j.cjca.2017.03.026

    Article  PubMed  Google Scholar 

  16. Sanchis J, Ruiz V, Bonanad C, Valero E et al (2017) Prognostic value of geriatric conditions beyond age after acute coronary syndrome. Mayo Clin Proc 92:934–939. https://doi.org/10.1016/j.mayocp.2017.01.018

    Article  PubMed  Google Scholar 

  17. Alonso Salinas GL, Sanmartin M et al (2017) Frailty is an independent prognostic marker in elderly patients with myocardial infarction. Clin Cardiol 40:925–931. https://doi.org/10.1002/clc.22749

    Article  PubMed  PubMed Central  Google Scholar 

  18. Alegre O, Formiga F, López-Palop R et al (2018) An easy assessment of frailty at baseline independently predicts prognosis in very elderly patients with acute coronary syndromes. J Am Med Dir Assoc 19:296–303. https://doi.org/10.1016/j.jamda.2017.10.007

    Article  PubMed  Google Scholar 

  19. Li Y, Zou Y, Wang S et al (2015) A pilot study of the FRAIL scale on predicting outcomes in Chinese elderly people with type 2 diabetes. J Am Med Dir Assoc 16:714.e7–714.e714. https://doi.org/10.1016/j.jamda.2015.05.019

    Article  Google Scholar 

  20. Alegre O, Ariza-Solé A, Vidán MT et al (2016) Impact of frailty and other geriatric syndromes on clinical management and outcomes in elderly patients with non-st-segment elevation acute coronary syndromes: rationale and design of the LONGEVO-SCA registry. Clin Cardiol 39:373–377. https://doi.org/10.1002/clc.22550

    Article  PubMed  PubMed Central  Google Scholar 

  21. Fox KA, Dabbous OH, Goldberg RJ et al (2006) Prediction of risk of death and myocardial infarction in the six months after presentation with acute coronary syndrome: prospective multinational observational study (GRACE). BMJ 333:1091. https://doi.org/10.1136/bmj.38985.646481.55

    Article  PubMed  PubMed Central  Google Scholar 

  22. Subherwal S, Bach RG, Chen AY et al (2009) Baseline risk of major bleeding in non-ST-segment-elevation myocardial infarction: the CRUSADE (Can Rapid risk stratification of Unstable angina patients suppress ADverse outcomes with Early implementation of the ACC/AHA Guidelines) bleeding score. Circulation 119:1873–1882. https://doi.org/10.1161/CIRCULATIONAHA.108.828541

    Article  PubMed  PubMed Central  Google Scholar 

  23. Abellan van Kan G, Rolland YM, Morley JE et al (2008) Frailty: toward a clinical definition. J Am Med Dir Assoc 9:71–72. https://doi.org/10.1016/j.jamda.2007.11.005

    Article  Google Scholar 

  24. Mahoney FI, Barthel DW (1965) Functional evaluation: the Barthel Index. A simple index of independence useful in scoring improvement in the rehabilitation of the chronically ill. Md State Med J 14:61–65

    CAS  PubMed  Google Scholar 

  25. Lawton MP, Brody EM (1969) Assessment of older people: self-maintaining and instrumental activities of daily living. Gerontologist 9:179–186

    Article  CAS  Google Scholar 

  26. Pfeiffer E (1975) A short portable mental status questionnaire for the assessment of organic brain deficit in elderly patients. J Am Geriatr Soc 23:433–441

    Article  CAS  Google Scholar 

  27. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  Google Scholar 

  28. Rubenstein LZ, Harker JO, Salvà A et al (2001) Screening for undernutrition in geriatric practice: developing the short-form mini-nutritional assessment. J Gerontol A Biol Sci Med Sci 56A:M366–M372

    Article  Google Scholar 

  29. Hasin T, Hochadel M, Gitt AK et al (2009) Comparison of treatment and outcome of acute coronary syndrome in patients with versus patients without diabetes mellitus. Am J Cardiol 103:772–778. https://doi.org/10.1016/j.amjcard.2008.11.034

    Article  PubMed  Google Scholar 

  30. Franklin K, Goldberg RJ, Spencer F et al (2004) Implications of diabetes in patients with acute coronary syndromes. The global registry of acute coronary events. Arch Intern Med 164:1457–1463. https://doi.org/10.1001/archinte.164.13.1457

    Article  PubMed  Google Scholar 

  31. Sardu C, Paolisso P, Sacra C et al (2018) Cardiac resynchronization therapy with a defibrillator (CRTd) in failing heart patients with type 2 diabetes mellitus and treated by glucagon-like peptide 1 receptor agonists (GLP-1 RA) therapy vs. conventional hypoglycemic drugs: arrhythmic burden, hospitalizations for heart failure, and CRTd responders rate. Cardiovasc Diabetol 17:137. https://doi.org/10.1186/s12933-018-0778-9

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  32. Sardu C, Marfella R, Santulli G (2014) Impact of diabetes mellitus on the clinical response to cardiac resynchronization therapy in elderly people. J Cardiovasc Transl Res 7:362–368. https://doi.org/10.1007/s12265-014-9545-9

    Article  PubMed  Google Scholar 

  33. Marfella R, Sardu C, Balestrieri ML et al (2018) Effects of incretin treatment on cardiovascular outcomes in diabetic STEMI-patients with culprit obstructive and multivessel non obstructive-coronary-stenosis. Diabetol Metab Syndr 10:1. https://doi.org/10.1186/s13098-017-0304-3

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Sardu C, Barbieri M, Balestrieri ML et al (2018) Thrombus aspiration in hyperglycemic ST-elevation myocardial infarction (STEMI) patients: clinical outcomes at 1-year follow-up. Cardiovasc Diabetol 17:152. https://doi.org/10.1186/s12933-018-0795-8

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Marfella R, Rizzo MR, Siniscalchi M et al (2013) Peri-procedural tight glycemic control during early percutaneous coronary intervention up-regulates endothelial progenitor cell level and differentiation during acute ST-elevation myocardial infarction: effects on myocardial salvage. Int J Cardiol 168:3954–3962. https://doi.org/10.1016/j.ijcard.2013.06.053

    Article  PubMed  Google Scholar 

  36. Vistisen D, Witte DR, Brunner EJ et al (2018) Risk of cardiovascular disease and death in individuals with prediabetes defined by different criteria: the Whitehall II Study. Diabetes Care 41:899–906. https://doi.org/10.2337/dc17-2530

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  37. Marfella R, Sardu C, Calabrò P et al (2018) Non-ST-elevation myocardial infarction outcomes in patients with type 2 diabetes with non-obstructive coronary artery stenosis: effects of incretin treatment. Diabetes Obes Metab 20:723–729. https://doi.org/10.1111/dom.13122

    Article  CAS  PubMed  Google Scholar 

  38. Balestrieri ML, Rizzo MR, Barbieri M et al (2015) Sirtuin 6 expression and inflammatory activity in diabetic atherosclerotic plaques: effects of incretin treatment. Diabetes 64:1395–1406. https://doi.org/10.2337/db14-1149

    Article  CAS  PubMed  Google Scholar 

  39. Sardu C, Pieretti G, D’Onofrio N et al (2018) Inflammatory cytokines and SIRT1 levels in subcutaneous abdominal fat: relationship with cardiac performance in overweight pre-diabetics patients. Front Physiol 9:1030. https://doi.org/10.3389/fphys.2018.01030

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Funding

The LONGEVO-SCA project has received a research grant from the Spanish Society of Cardiology (Proyectos de Investigaci?n Cl?nica SEC 2015).

Author information

Authors and Affiliations

  1. Cardiology Department, Bellvitge University Hospital, Feixa Llarga s/n, L’Hospitalet de Llobregat, 08907, Barcelona, Spain

    Miquel Gual, Francesc Formiga, Albert Ariza-Solé, José C. Sánchez-Salado, Victòria Lorente, Oriol Alegre & Àngel Cequier

  2. Hosptal Universitario San Juan, Alicante, Spain

    Ramon López-Palop & Alberto Cordero

  3. Hospital Clínico Universitario de Valencia, INCLIVA, Universidad de Valencia, CIBER-CV, Valencia, Spain

    Juan Sanchís

  4. Hospital Virgen de la Arrixaca, IMIB-Arrixaca, CIBER-CV, Murcia, Spain

    Francisco Marín

  5. Hospital General Universitario Gregorio Marañón, Madrid, Spain

    María T. Vidán & Manuel Martínez-Sellés

  6. CIBERCV, Universidad Complutense, Universidad Europea, Madrid, Spain

    Manuel Martínez-Sellés

  7. Hospital de la Santa Creu i Sant Pau, Universitat Autònoma de Barcelona, Barcelona, Spain

    Alessandro Sionis & Miquel Vives-Borrás

  8. Hospital Unversitario La Princesa, Madrid, Spain

    Pablo Díez-Villanueva

  9. Hospital Doce de Octubre, Madrid, Spain

    Héctor Bueno

  10. Centro Nacional de Investigaciones Cardiovasculares, Madrid, Spain

    Héctor Bueno

  11. Hospital Álvaro Cunqueiro, Vigo, Spain

    Emad Abu-Assi

Authors
  1. Miquel Gual
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Francesc Formiga
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Albert Ariza-Solé
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ramon López-Palop
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Sanchís
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Francisco Marín
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. María T. Vidán
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Manuel Martínez-Sellés
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Alessandro Sionis
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. José C. Sánchez-Salado
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Victòria Lorente
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Pablo Díez-Villanueva
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Miquel Vives-Borrás
    View author publications

    You can also search for this author in PubMed Google Scholar

  14. Alberto Cordero
    View author publications

    You can also search for this author in PubMed Google Scholar

  15. Héctor Bueno
    View author publications

    You can also search for this author in PubMed Google Scholar

  16. Oriol Alegre
    View author publications

    You can also search for this author in PubMed Google Scholar

  17. Emad Abu-Assi
    View author publications

    You can also search for this author in PubMed Google Scholar

  18. Àngel Cequier
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

the LONGEVO-SCA registry investigators

Corresponding author

Correspondence to Albert Ariza-Solé.

Ethics declarations

Conflict of interest

The authors declare no conflict of interest.

Statement of human and animal rights

All procedures performed in this study were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 68 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gual, M., Formiga, F., Ariza-Solé, A. et al. Diabetes mellitus, frailty and prognosis in very elderly patients with acute coronary syndromes. Aging Clin Exp Res 31, 1635–1643 (2019). https://doi.org/10.1007/s40520-018-01118-x

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40520-018-01118-x

Keywords

Search

Navigation