Original Research Article
Year: 2019 | Month: September | Volume: 6 | Issue: 9 | Pages: 337-345
Differences in Clinical Characteristics, Management and In-Hospital Outcomes among Diabetic versus Non Diabetic Patients with Acute Coronary Syndrome
Navdeep Singh Sidhu1, Sumandeep Kaur2, Sunil Kumar Kondethimmanahally Rangaiah3,Dwarikaprasad Ramesh4
1Assistant Professor, Department of Cardiology, GGS Medical College and Hospital, Faridkot, Punjab, India.
2MSc, PhD. University College of Nursing, Baba Farid University of Health Sciences, Faridkot, Punjab, India.
3Associate Professor, Department of Cardiology, Sri Jayadeva Institute of Cardiovascular Sciences & Research, Bangalore, India.
4Professor and Head of Department, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, India.
Corresponding Author: Navdeep Singh Sidhu
ABSTRACT
Introduction: Diabetes mellitus is one of the strongest risk factors for coronary artery disease (CAD). Many Western studies have shown worse outcomes in diabetic acute coronary syndrome (ACS) patients as compared to non diabetics. This study was conducted to explore the clinical characteristics, management strategies and in-hospital outcomes in ACS patients with or without diabetes.
Materials and methods: We enrolled consecutive adult ACS patients admitted during a period of 12 months (February 2015 to January 2016)
Results: In 621 ACS patients, prevalence of diabetes was 37.2%. Mean age of diabetics was higher than non diabetics (58.26 vs 54.76 years, p=0.000) and females constituted higher proportion in diabetic group (31.6% vs 19.7%, p=0.000). Diabetic patients had higher prevalence of hypertension (64.5% vs 23.8%, p=0.000) and more frequent past history of ischemic heart disease (26% vs 16.9%, p=0.007). Diabetics had higher prevalence of triple vessel disease (27.1% vs 14.6%, p=0.000) and left main disease (6.1% vs 2.5%, p=0.042). Use of evidence based pharmacotherapy was similar in two groups except for the lesser use of beta blockers in diabetics (74.5% vs 84.6%, p=0.001). Although revascularization rates with percutaneous coronary intervention and bypass surgery were similar in two groups, diabetic patients had higher in-hospital major adverse cardiovascular events (29.4% vs 13.1%, p=0.000) and higher in-hospital mortality (5.2% vs 2.1%, p=0.029).
Conclusion: Patients with diabetes were older, more likely to be females and had higher comorbidities like hypertension and past IHD. Diabetic patients had higher prevalence of complex CAD including TVD and left main disease and had higher in-hospital MACE including mortality.
Key words: acute coronary syndrome, coronary artery disease, ischemic heart disease, diabetes mellitus, percutaneous coronary intervention, bypass surgery, major adverse cardiovascular events, mortality, triple vessel disease, left main disease
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