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Diabetic patients with acute coronary syndrome - higher risk and less warning signs
Session:
Posters - E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Speaker:
Mafalda Carrington
Congress:
CPC 2021
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.6 Acute Coronary Syndromes - Clinical
Session Type:
Posters
FP Number:
---
Authors:
Mafalda Carrington; Rita Rocha; Francisco Cláudio; Miguel Carias; João Pais; Diogo Brás; David Neves; Bruno Piçarra; Rita Santos; Manuel Trinca
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> There is evidence in the literature reporting a higher prevalence of silent ischemia in diabetics, the possible reason being that diabetic neuropathy may also affect the perception of angina by these patients. In our daily practice, the assumption that diabetic with an acute coronary syndrome (ACS) may have less chest pain may increase our suspicion of ACS and referral for invasive treatment in the absence of typical symptoms. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong> Our aim was to determine if the clinical and electrocardiographic presentation of an ACS was different between diabetic and non-diabetic patients. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> We performed an observational retrospective study based on a multicentric national registry, in which we included all patients with ACS. We compared diabetic and non-diabetic patients in terms of their clinical and electrocardiographic features</span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> at presentation and performed a multivariate logistic regression to determine if diabetes mellitus (DM) was independently associated with development of chest pain as a predominant symptom of ACS. We also compared both groups outcomes, by measuring admission timings, management, and in-hospital mortality (IHM).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong> Among a total of 18 827 patients with ACS, 31% (n=5864) had DM. Diabetic patients were older (69±11 vs 65±14, p<0,001), had a higher proportion of females (32% vs 25%, p<0,001) and more co-morbidities, including previous angina pectoris (31% vs 20%,p<0,001). They presented less frequently with chest pain (87% vs 93%,p<0,001) and more with dyspnea (7% vs 3%, p<0,001) and fatigue (1% vs 0,4%, p<0,001), and they were more frequently diagnosed with non-ST elevation myocardial infarction (NSTEMI) (55% vs 46%, p<0,001) and unstable angina (UA) (7% vs 6%, p=0,035). After adjusting for clinical variables and coronary artery anatomy, DM was associated with a 33% less probability of presenting with angina as the predominant symptom of ACS (OR 0.67; IC95%0.55-0.81). This was also true in the subgroup of patients with STEMI (OR 0.70; IC95%0,51-0,96) and in those with previous history of angina pectoris (OR 0.62; IC95%0.41-0.94). Finally, DM was associated with an increased time from symptom onset to first medical contact (FMC >2h in 67% vs 60%, p<0,001), as well as the time from symptom onset to reperfusion in STEMI patients (>2h in 94% vs 90%, p<0,001). IHM in diabetics was 4%, compared to 3% in non-diabetics (p<0,001).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>We conclude that DM decreases the probability of presenting with angina in patients with ACS and that diabetics have delayed FMC timings and higher in-hospital mortality. This negative effect of DM on angina experience was also present in the subgroup of STEMI patients, in which DM was also associated with delayed reperfusion. Consequently, in our daily practice as physicians, we should monitor more closely diabetic patients who may benefit from earlier referring to invasive treatment in the absence of typical angina.</span></span></p>
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