***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: CONTEXT The worldwide epidemic of diabetes mellitus is increasing the burden of cardiovascular disease , the leading cause of death among persons with diabetes . The independent effect of diabetes on mortality following acute coronary syndromes ( ACS ) is uncertain . OBJECTIVE To evaluate the influence of diabetes on mortality following ACS using a large data base spanning the full spectrum of ACS . DESIGN , SETTING , AND PATIENTS A subgroup analysis of patients with diabetes enrolled in r and omized clinical trials that evaluated ACS therapies .  Patients with ACS in 11 independent Thrombolysis in Myocardial Infa rct ion ( TIMI ) Study Group clinical trials from 1997 to 2006 were pooled , including 62,036 patients ( 46,577 with ST-segment elevation myocardial infa rct ion [ STEMI ] and 15,459 with unstable angina/non-STEMI [ UA/NSTEMI ] ) , of whom 10 613 ( 17.1 % ) had diabetes . A multivariable model was constructed to adjust for baseline characteristics , aspects of ACS presentation , and treatments for the ACS event . MAIN OUTCOME MEASURES Mortality at 30 days and 1 year following ACS among patients with diabetes vs patients without diabetes . RESULTS Mortality at 30 days was significantly higher among patients with diabetes than without diabetes presenting with UA/NSTEMI ( 2.1 % vs 1.1 % , P < .001 ) and STEMI ( 8.5 % vs 5.4 % , P < .001 ) . After adjusting for baseline characteristics and features and management of the ACS event , diabetes was independently associated with higher 30-day mortality after UA/NSTEMI ( odds ratio [ OR ] , 1.78 ; 95 % confidence interval [ CI ] , 1.24 - 2.56 ) or STEMI ( OR , 1.40 ; 95 % CI , 1.24 - 1.57 ) . Diabetes at presentation with ACS was associated with significantly higher mortality 1 year after UA/NSTEMI ( hazard ratio [ HR ] , 1.65 ; 95 % CI , 1.30 - 2.10 ) or STEMI ( HR , 1.22 ; 95 % CI , 1.08 - 1.38 ) . By 1 year following ACS , patients with diabetes presenting with UA/NSTEMI had a risk of death that approached patients without diabetes presenting with STEMI ( 7.2 % vs 8.1 % ) . CONCLUSION Despite modern therapies for ACS , diabetes confers a significant adverse prognosis , which highlights the importance of aggressive strategies to manage this high-risk population with unstable ischemic heart disease OBJECTIVE Diabetes has been shown to be associated with worse survival and repeat target vessel revascularization ( TVR ) after primary angioplasty . The aim of the current study was to evaluate the impact of diabetes on long-term outcome in patients undergoing primary angioplasty treated with bare metal stents ( BMS ) and drug-eluting stents ( DES ) .  RESEARCH DESIGN AND METHODS Our population is represented by 6,298 ST-segment elevation myocardial infa rct ion ( STEMI ) patients undergoing primary angioplasty included in the DESERT data base from 11 r and omized trials comparing DES with BMS .  RESULTS Diabetes was observed in 972 patients ( 15.4 % ) who were older ( P < 0.001 ) , more likely to be female ( P < 0.001 ) , with higher prevalence of hypertension  ( P < 0.001 ) , hypercholesterolemia ( P < 0.001 ) , and longer ischemia time  ( P < 0.001 ) , and without any difference in angiographic and procedural characteristics . At long-term follow-up ( 1,201 ± 441 days ) , diabetes was associated with higher rates of death ( 19.1 % vs. 7.4 % ; P < 0.0001 ) , reinfa rct ion ( 10.4 % vs. 7.5 % ; P < 0.001 ) , stent thrombosis ( 7.6 % vs. 4.8 % ; P = 0.002 ) with similar temporal distribution — acute , subacute , late , and very late — between diabetic and control patients , and TVR ( 18.6 % vs. 15.1 % ; P = 0.006 ) . These results were confirmed in patients receiving BMS or DES , except for TVR , there being no difference observed between diabetic and nondiabetic patients treated with DES . The impact of diabetes on outcome was confirmed after correction for baseline confounding factors ( mortality , P < 0.001 ; repeat myocardial infa rct ion , P = 0.006 ; stent thrombosis , P = 0.007 ; TVR , P = 0.027 ) . CONCLUSIONS This study shows that among STEMI patients undergoing primary angioplasty , diabetes is associated with worse long-term mortality , reinfa rct ion , and stent thrombosis in patients receiving DES and BMS . DES implantation , however , does mitigate the known deleterious effect of diabetes on TVR after BMS OBJECTIVES To compare the use of evidence -based pharmacological and invasive treatments and 12-month mortality rates between patients with and without diabetes who present with acute myocardial infa rct ion ( MI ) , and to explore the relationship between these treatments and late clinical outcomes . DESIGN AND SETTING Prospect i ve , nationwide multicentre registry : the Acute Coronary Syndrome Prospect i ve Audit ( ACACIA ) . PATIENTS Patients presenting to 24 metropolitan and 15 non-metropolitan hospitals with acute coronary syndrome ( ACS ) and a final discharge diagnosis of acute MI between November 2005 and July 2007 . MAIN OUTCOME MEASURE All-cause mortality at 12 months . RESULTS Nearly a quarter of 1744 patients with a final diagnosis of acute MI had a history of diabetes on presentation . Patients with diabetes were older , with a greater prevalence of comorbidities than non-diabetic patients , and were less likely to be treated at discharge with evidence -based medications ( aspirin , clopidogrel , a statin and /or a beta-blocker ) or to receive early invasive procedures . After adjusting for baseline characteristics and therapeutic interventions , diabetes at presentation was independently associated with a higher mortality at 12 months after MI ( hazard ratio , 1.79 ; 95 % CI , 1.18 - 2.72 ; P=0.007 ) . Early invasive management and discharge prescription of guideline -recommended medications were associated with a significantly reduced hazard of mortality at 12 months . CONCLUSION Patients with diabetes have a higher risk than non-diabetic patients of late mortality following an acute MI , yet receive fewer guideline -recommended medications and early invasive procedures . Increased application of proven pharmacotherapies and an early invasive management strategy in patients with diabetes presenting with ACS might improve their outcomes . STUDY PROTOCOL NUMBER ( SANOFI-AVENTIS ) : PML-0051 OBJECTIVE —Elevation of blood glucose is a common metabolic disorder among patients with acute myocardial infa rct ion ( AMI ) and is associated with adverse prognosis . However , few data are available concerning the long-term prognostic value of elevated fasting glucose during the acute phase of infa rct ion . RESEARCH DESIGN AND METHODS —We prospect ively studied the relationship between fasting glucose and long-term mortality in patients with AMI .  Fasting glucose was determined after an ≥8 h fast within 24 h of admission . The median duration of follow-up was 24 months ( range 6–48 ) . All multivariable Cox models were adjusted for the Global Registry of Acute Coronary Events ( GRACE ) risk score . RESULTS —In nondiabetic patients ( n = 1,101 ) , compared with patients with normal fasting glucose ( < 100 mg/dl ) , the adjusted hazard ratio for mortality progressively increased with higher tertiles of elevated fasting glucose ( first tertile 1.5 [ 95 % CI 0.8–2.9 ] , P = 0.19 ; second tertile 3.2 [ 1.9–5.5 ] , P < 0.0001 ; third tertile 5.7 [ 3.5–9.3 ] , P < 0.0001 ) . The c statistic of the model containing the GRACE risk score increased when fasting glucose data were added ( 0.8 ± 0.02–0.85 ± 0.02 , P = 0.004 ) . Fasting glucose remained an independent predictor of mortality after further adjustment for ejection fraction . Elevated fasting glucose did not predict mortality in patients with diabetes ( n = 462 ) . CONCLUSIONS —Fasting glucose is a simple robust tool for predicting long-term mortality in nondiabetic patients with AMI . Fasting glucose provides incremental prognostic information when added to the GRACE risk score and left ventricular ejection fraction . Fasting glucose is not a useful prognostic marker in patients with diabetes OBJECTIVE This analysis was undertaken to determine the composite incidence of cumulative adverse events ( death , reinfa rct ion , disabling stroke , and target vessel revascularization ) at the end of the first year after acute myocardial infa rct ion , in diabetic patients who underwent coronary stenting or primary coronary balloon angioplasty .  METHODS From the STENT PAMI trial , we analyzed the 6-month angiographic and 1-year clinical outcomes of 135 diabetic ( 112 , noninsulin dependent ) patients who underwent the r and omization process of the trial and compared them with 758 nondiabetic patients . RESULTS Coronary stenting did not significantly reduce the primary composite clinical end point when compared with PTCA ( 20 vs. 30 % , p=0.2 ) . A significant benefit from stenting was observed in patients with noninsulin dependent diabetes , with a trend toward a lesser need for new revascularization procedures ( 10 vs. 21 % , p<.001 ) , with a significant reduction in the primary composite clinical end point at 1 year ( 12 vs. 28 % , p=. 04 ) . At 6 months , the restenosis rate were significantly reduced only in nondiabetic patients ( 18 vs. 33 % , p<. 001 ) . Diabetic patients had the same restenosis rate ( 38 % ) either with stenting or balloon PTCA . CONCLUSIONS Coronary Stenting in diabetics noninsulin dependent offered a significant reduction in the composite incidence of major clinical adverse events compared with balloon PTCA BACKGROUND It has been shown that , among patients with ST-segment elevation myocardial infa rct ion ( STEMI ) , diabetes is associated with a significantly higher mortality . The aim of this study was to investigate in a large cohort of patients the impact of diabetes on mortality in a large cohort of patients with STEMI treated with primary angioplasty .  METHODS Our population is represented by consecutive patients with STEMI treated by primary angioplasty and enrolled in the POLISH registry in 2003 . All clinical , angiographic , and follow-up data were prospect ively collected . Diagnosis of diabetes was based on history of diabetes at admission . RESULTS Among 7193 patients , 877 ( 12.2 % ) had diabetes at admission . Diabetes was associated with more advanced age ( p<0.0001 ) , higher prevalence of female gender ( p<0.0001 ) , hyperlipidemia ( p<0.0001 ) , shock at presentation ( p<0.0001 ) , renal failure ( p<0.0001 ) , previous myocardial infa rct ion ( p<0.0001 ) , more often treated after 6h from symptom onset ( p<0.0001 ) . Diabetes was associated with more extensive coronary artery disease ( p<0.0001 ) , less often treated with stenting ( p<0.0001 ) . Diabetes was significantly associated with impaired epicardial reperfusion ( TIMI 0 - 2 : OR [ 95 % CI]=1.81 [ 1.5 - 2.18 ] , p<0.0001 ) , that persisted after correction for baseline confounding factors ( OR [ 95 % CI]=1.33 [ 1.075 - 1.64 ] , p=0.009 ) . At a mean follow-up of 524+/-194 days , diabetes was associated with higher mortality ( unadjusted cumulative mortality : 23.5 % vs. 12.6 % , unadjusted HR=1.95 [ 1.66 - 2.3 ] , p<0.0001 ) , that persisted after correction for confounding factors ( adjusted cumulative mortality : 13.3 % vs. 10.7 % , adjusted HR=1.2 
    Output:
    
Despite medical advances , individuals with diabetes have a 50 % greater long-term mortality compared with those without .