• Anna Baeza Román, Jaime Latour Pérez, Eva de Miguel Balsa, Karel Pino Izquierdo, Francisco Javier Coves Orts, Luis García Ochando, Maria José de la Torre Fernández, and Grupo ARIAM-SEMICYUC.
• Unidad de Cuidados Intensivos, Hospital General Universitario de Elche, Elche, Alicante, España. Electronic address: anna.baeza@coma.es.
• Med Clin Barcelona. 2014 May 20;142(10):427-31.

Background And ObjectivesIn the management of non-ST-segment elevation acute coronary syndromes (NSTE-ACS), several studies have shown a reduction in mortality with the use of an invasive strategy in high-risk patients, including diabetic patients. Paradoxically, other studies have shown an under-utilization of this invasive strategy in these patients. The aim of this study is to determine the characteristics of patients managed conservatively and identify determinants of the use of invasive or conservative strategy.Patients And MethodsRetrospective cohort study conducted in diabetic patients with NSTE-ACS included in the ARIAM-SEMICYUC registry (n=531) in 2010 and 2011. We performed crude and adjusted unconditional logistic regression.ResultsWe analyzed 531 diabetic patients, 264 (49.7%) of which received invasive strategy. Patients managed conservatively were a subgroup characterized by older age and cardiovascular comorbidity, increased risk of bleeding and the absence of high-risk electrocardiogram (ECG). In diabetic patients with NSTE-ACS, independent predictors associated with conservative strategy were low-risk ECG, initial Killip class>1, high risk of bleeding and pretreatment with clopidogrel.ConclusionsThe fear of bleeding complications or advanced coronary lesions could be the cause of the underutilization of an invasive strategy in diabetic patients with NSTE-ACS.Copyright © 2012 Elsevier España, S.L. All rights reserved.

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