To the Editor: In their study of diabetes and mortality following acute coronary syndromes (ACS), Dr Donahoe and colleagues1 reported higher mortality in patients at 30 days and 1 year after ACS by performing subgroup analysis on pooled data from 11 independent Thrombolysis in Myocardial Infarction (TIMI) trials. The authors state that mortality remains high despite available modern evidence-based treatment. However, the data presented show that proven and available measures for secondary prevention remain underused. Adverse clinical outcomes and underuse of secondary prevention strategies have been reported to be associated with worse clinical outcomes in patients with diabetes presenting with ACS.2 - 3
In the study by Donahoe et al, hypolipidemic therapy was used at hospital discharge in 63.5% of patients with diabetes compared with 63.7% of patients without diabetes (P = .84). The CURE study4 showed that dual antiplatelet therapy with 3 to 12 months of thienopyridines such as clopidogrel added to aspirin reduced death from cardiovascular causes following ACS. Thienopyridine use at discharge in this analysis was approximately 30%, irrespective of diabetic status. The optimal revascularization strategy for ACS in patients with diabetes is unclear. However, of the 25% of patients who underwent percutaneous coronary interventions, it is likely that drug-eluting stents were used in the majority of patients with diabetes with ACS. Some clinical events in patients with diabetes may have been related to late stent thrombosis.5
We agree with the need to identify effective new strategies to manage ACS in patients with diabetes. However, the immediate need may be to create systems to ensure rigorous and universal implementation of available secondary prevention strategies that have been proven to be cost-effective.
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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