Prognostic value of elevated biomarkers in diabetic and non-diabetic patients admitted for acute coronary syndromes

Diabetes is not only a predisposing factor for cardiovascular disease but once diabetic patients develop coronary artery disease (CAD) they have significantly worse outcomes compared to non-diabetic patients.1,2 Diabetes is an independent risk factor for a worse outcome after presentation with acute coronary syndrome (ACS).2 Prior studies have demonstrated that diabetic patients without previous myocardial infarction have as high a risk as non-diabetic patients with previous myocardial infarction.3 Based on this and other studies, diabetes is considered a CAD equivalent or, in other words, patients with diabetes should be treated as already having vascular disease. Elevated cardiac enzymes, both creatine kinase myocardial band (CK-MB) and troponin, have been demonstrated to be important prognostic determinants of patients with ACS and to identify high risk patients.4 The prognostic implications of elevated biomarkers in diabetic patients who are already considered to be at high risk have not been systematically studied. The primary objective was to analyse the prognostic implication of elevated biomarkers in patients with and without diabetes in predicting six month mortality. We studied 1951 consecutive patients who were admitted to the University of Michigan Medical Center from 27 December 1998 to 16 October 2002 with a diagnosis of ACS. The protocol was approved by the institutional review board at the University of Michigan and informed consent obtained from all patients. …