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Johann Trutz, Aurel Babeș and Katalin Babeș


Background and Aims. Several factors are associated with a heightened risk of subsequent events, morbidity and mortality in patients with type 2 diabetes mellitus (T2DM) after an acute coronary syndrome (ACS). Improving the management of these patients is a challenge that requires urgent attention. We aimed to study the long-term effect of the change in treatment strategy depending on the HbA1c level detected during the hospitalization for ACS. Material and methods. The primary endpoints of this study were the major adverse cardiac events (MACE) at 12 months. From the originally included 221 patients 15 were lost (no response to follow-up phone calls). The suboptimal glycaemic control group (HbA1c>7.0%, n=84) was divided in two subgroups: patients who completed a diabetological consult with further treatment changes (intervention group) and patients without this referral (control group). Results. No significant differences in baseline characteristics were found between the 2 subgroups. The second subgroup had a triple risk for a MACE in 1 year (HR=2.8704, 95% CI: 1.109-7.423, p=0.0296) compared to the intervention group. No significant differences were found in secondary endpoints. Conclusion. This study suggests that, after hospitalization for an ACS, diabetologist referral and treatment strategy changes are recommended for all T2DM patients whose HbA1c level is over 7% before discharge.

Open access

Johann Trutz, Aurel Babeş and Katalin Babeş


Background and Aims. The identification of type 2 diabetes mellitus (T2DM) patients with high cardio-vascular risk became more crucial, especially in patients with known coronary artery disease (CAD). Our study is focusing on T2DM patients who suffered recently an acute coronary syndrome (ACS), and evaluates the importance of albuminuria and NT-proBNP level as risk factors for short-term recurrence.

Material and methods. 221 T2DM patients with recent ACS were evaluated 1 month after discharge, assessing NT-proBNP and albuminuria level and followed for 12 months for major adverse cardiac events (MACE).

Results. Patients who reached the endpoint (33%) presented significantly higher levels of NT-proBNP (458.5 vs. 207.4 pg/ml, p<0.0001) and urinary albumin/creatinine ratio (80 vs. 27 mg/g, p<0.0001) than those who did not present a MACE in the follow-up period. Comparison of the MACE-free survival curves revealed that NT-proBNP has a better power than albuminuria in the prediction of the short-term outcome: hazard ratio (HR)=1.6176 (95%CI: 1.0047-2.6044), p=0.0433 vs. HR=1.4813 (95%CI: 0.8497-2.5824), p=0.1921. Only the NT-proBNP level entered the multivariable regression model besides age and represents an independent risk factor (HR=1.0025, 95%CI: 1.0014-1.0035, p=0.0036).

Conclusion. NT-proBNP provides excellent prognostic information in patients with diabetes mellitus who recently suffered an ACS. Albuminuria wasn’t an independent risk factor in this cohort.

Open access

Tiberius Mogoş, Carmen Dondoi, Claudia Chelan and Andra Evelin Iacobini

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