Acute coronary syndrome in patients with diabetes mellitus: unified data of multicenter observational trials ORACLE I and ORACLE II


DOI: https://dx.doi.org/10.18565/therapy.2019.1.68-80

Minushkina L.O., Brazhnik V.A., Averkova A.O., Rogozhina A.A., Evdokimova M.A., Korolyova O.S., Sizgunov D.S., Zubova E.A., Karmanchikova E.A., Galyavich A.S., Khasanov N.R., Ivantsov E.N., Magamedkerimova F.A., Chichkov Yu.M., Chichkova M.A., Kovalenko N.V., Tereshchenko S.N., Koziolova N.A., Glezer M.G., Boeva O.I., Khorolets E.V., Konstantinov V.O., Guliyev R.R., Zateyshchikov D.A.

Central State Medical Academy, Moscow; City Clinical Hospital N 51 of the Moscow Healthcare Department, Moscow; Stavropol Regional Clinical Specialized Psychiatric Hospital N 1, Stavropol; Kazan State Medical University, Kazan; City Clinical Hospital N 17 of the Moscow Healthcare Department, Moscow; National Medical Research Center of Cardiology, Moscow; Perm State Medical University named after Academician E.A. Wagner, Perm; First Moscow State Medical University named after IM. Sechenov, Moscow; Stavropol State Medical University, Stavropol; Rostov State Medical University, Rostov-on-Don; North-West State Medical University named after I.I. Mechnikov, St. Petersburg; Institute of Biochemical Physics named after N.M. Emanuel, Moscow
The article presents data on the course and prognosis of acute coronary syndrome (ACS) in patients with diabetes mellitus (DM), obtained in two open observational studies – ORACLE I (2004–2007) and ORACLE II (2014–2017). The results of the observation of 2695 patients with ACS were analyzed. In the ORACLE I study, there were 175 (14,7%) patients with diabetes - 1 patient with type I diabetes and 174 patients with type II diabetes. In the ORACLE II study, there were 354 patients with diabetes (23,6%) – 7 patients with type I diabetes and 347 patients with type II diabetes. Differences in the frequency of diabetes were significant (p <0,01). In patients with diabetes mellitus, both in the ORACLE I and ORACLE II cohorts, the frequencies of cardiovascular deaths (MI, sudden death, death from heart failure, pulmonary embolism) and all deaths were higher. The frequencies of stroke deaths and non-cardiac deaths didn’t differ significantly. Mortality from any causes in the registers ORACLE I and II was not significantly different. A history of arterial hypertension, myocardial infarction, heart failure, reduced glomerular filtration rate and increased glycemia upon admission to the hospital were independently associated with the risk of an adverse outcome in patients without diabetes mellitus. In patients with DM, univariate analysis showed an association with an unfavorable outcome for only 3 factors – history of myocardial infarction and heart failure and a decrease in glomerular filtration rate. Impaired renal function in multivariate regression analysis has lost a significant association with the development of an adverse outcome.
Keywords: antithrombotic therapy, acute coronary syndrome, diabetes mellitus, mortality
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About the Autors

Larisa O. Minushkina, MD, PhD, professor of the therapy, cardiology and functional diagnostics Department of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: minushkina@mail.ru
Viktoria A. Brazhnik, MD, PhD, associate professor of the therapy, cardiology and functional diagnostics Department of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: vabrahznik@bk.ru
Anastasia O. Averkova, postgraduate student of therapy, cardiology and functional Department of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: avek@mail.ru
Anastasia A. Rogozhina, postgraduate student of therapy, cardiology and functional Department of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: rogozhina007@list.ru
Andreevna E. Marina, physician, City clinical hospital №51, Moscow city healthcare Department. Address: 121309 Moscow, st. Alyabyev, 7/33. E-mail: onlygarbagecan@list.ru
Olga S. Koroleva, MD, PhD, assistant of of therapy, cardiology and functional Department of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: olgakoroleva@hotmail.com
Sizgunov Dmitry Sergeevich, physician, City Clinical Hospital №51, Moscow city Healthcare Department. Address: 121309 Moscow, st. Alyabyev, 7/33.
Ekaterina A. Zubova, physician, City clinical hospital №51, Moscow City healthcare Department.
Address: 121309 Moscow, st. Alyabyev, 7/33. E-mail: zubova.katerinka@inbox.ru
Elena A. Karmanchikova, general practitioner of the State budgetary healthcare institution «Stavropol regional clinical specialized psychiatric hospital №1». Address: 355038 Stavropol, 441 Lenin str. E-mail: dr.lena81@gmail.com
Albert S. Galyavich, MD, PhD, professor, head of the Department of therapy of the Federal State budgetary institution of high education «Kazan State Medical University» of the Ministry of Health of the Russian Federation. Address: 420012, Volga Federal District, RT, Kazan, 49 Butlerova str. E-mail: galyavich@inbox.ru
Niyaz R. Khasanov, MD, associate professor, head of the Department of internal medicine propaedeutics of the Federal State budgetary institution of high education «Kazan State Medical University» of the Ministry of Health of the Russian Federation. Address: 420012, Volga Federal District, RT, Kazan, 49 Butlerova str. E-mail: ybzp@mail.ru
Evgeny N. Ivantsov, assistant of the Department of internal diseases propedeutics of the Federal State budgetary institution of high education «Kazan State Medical University» of the Ministry of Health of the Russian Federation. Address: 420012, Volga Federal District, RT, Kazan, 49 Butlerova str.. Tel.: (843) 236-06-52
Ferida A. Magamedkerimova, postgraduate student, Department of internal diseases propedeutics of the Federal State budgetary institution of high education «Kazan State Medical University» of the Ministry of Health of the Russian Federation. Address: 420012, Volga Federal District, RT, Kazan, 49 Butlerova str. Tel.: (843) 236-06-52
Yuri M. Chichkov, resident of the Department of therapy, cardiology and functional diagnostics of the Federal State budgetary institution of postgraduate education «Central State medical Academy» of the administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. E-mail: m.chichkova@mail.ru
Marina A. Chichkova, MD, PhD, professor, Deputy Head Doctor of the City clinical hospital №17 of the Moscow healthcare Department. Address: 119620 Moscow, 7 Volynskaya str. E-mail: m.chichkova@mail.ru
Natalia V. Kovalenko, PhD, cardiologist, City clinical hospital №51 of the Moscow city healthcare Department. Address: 121309 Moscow, Alyabyev st., 7/33. E-mail: kovalenkonatasha1@rambler.ru
Sergey N. Tereshchenko, MD, PhD, professor, First Deputy General Director, Deputy General Director for Research, head of the Department of myocardial diseases and heart failure of the Federal State budgetary institution «National medical research Center for cardiology» of the Ministry of Healthcare of the Russian Federation. Address: 121552, Moscow, 15A 3 Cherepkovskaya str. E-mail: stereschenko@yandex.ru
Natalia A. Koziolova, MD, PhD, professor, head of the Department of internal medicine propaedeutics №2 of Perm State Medical University named after Academician E.A. Wagner of the Ministry of Healthcare of the Russian Federation. Address: 614000 Perm, Petropavlovskaya st, 26. E-mail: koziolova@inbox.ru
Maria G. Glezer, MD, PhD, Professor, professor of the Department of preventive and emergency cardiology of the State budgetary institution of high education «First Moscow State Medical University named after I.М. Sechenov» of the Ministry of Healthcare of the Russian Federation. Address: Moscow, 119991, 8/2 Trubetskaya str. E-mail: glezermg@mtu-net.ru
Boeva I. Olga Igorevna, MD, PhD, head of the imaging Department with postgraduate education course of the State Budgetary Institution of High Education «Stavropol State Medical University» of the Ministry of Healthcare of the Russian Federation. Address: 355017, 310 Stavropol Mira str.
E-mail: box0271@mail.ru
Ekaterina V. Khorolets, MD, PhD, assistant of the Department of internal diseases №4 of the Federal State budgetary institution of high education «Rostov State medical University» of the Ministry of Healthcare of the Russian Federation. Address: 344068 Rostov-on-Don, 88/35 Bodraya str. E-mail: kata_maran@mail.ru
VladimirO. Konstantinov, MD, PhD, professor of the Department of hospital therapy of the Federal State Budgetary institution of high education «North-Western State Medical University named after I.I. Mechnikov» of the Ministry of Healthcare of the Russian Federation. Address: 194017 St. Petersburg, 11-30 Dresden str. E-mail: atherosclerosis@mail.ru
Rustam R. Guliev, researcher of the Federal State budgetary scientific institution «Institute for Biochemical Physics named after N.M. Emanuel» of the Russian Academy of Sciences. Address: 119334 Moscow,
4 Kosygina str. E-mail: glvrst@gmail.com
Dmitry A. Zateyshchikov, MD, PhD, professor, head of the therapy, cardiology and functional diagnostics Department of the Federal State Budgetary Institution of Postgraduate Education «Central State Medical Academy» of the Administrative Department of the President of the Russian Federation. Address: 121359 Moscow, 1/1A Marshal Timoshenko str. Head of the Primary Vascular Department of the City Clinical Hospital №51, Moscow Healthcare Department. Address: 121309 Moscow, 7/33 Alyabyev str. E-mail: dz@bk.ru


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