The baseline clinical characteristics, demographics, and risk factors are listed in . From the 1697 patients enrolled with an ACS, 668 (39.4%) had diabetes, whereas 1029 (60.6%) did not. Patients with diabetes who had an ACS were older, with a mean age of 55.6 ± 11.2 years compared to 50.5 ± 11.5 years for nondiabetics (P < 0.001). There was a higher proportion of females in the diabetic group (19% compared to 8.2%, P < 0.001). Furthermore, ACS patients with diabetes had a significantly higher body mass index than those without diabetes and were more likely to have a prior history of hypertension, hyperlipidemia, coronary artery disease, coronary artery revascularization, stroke, or peripheral vascular disease, but were less likely to be current smokers (). Atypical chest pain and dyspnea as the predominant presenting symptoms were more common in diabetic patients when compared to nondiabetics. Diabetic patients with ACS were less likely to present with an STEMI and more likely to have an NSTE-ACS compared to patients without diabetes. During hospitalization, those with diabetes were more likely to have Killip class II–IV heart failure and renal impairment.
Demographic and other baseline characteristics of the studied subjects (n = 1697).
demonstrates the in-hospital management of the ACS patients. Both groups received aspirin, clopidogrel, heparin, beta-blockers, thrombolytics, and lipid-lowering agents. 194 patients (29.1%) in the diabetic group and 334 patients (32.5%) in the nondiabetic group underwent coronary angiography (CAG). However, patients with diabetes were more likely to be treated with glycoprotein (GP) IIb/IIIa antagonists, angiotensin-converting enzyme (ACE) inhibitors, or beta-blockers (BBs).
In-hospital management of acute coronary syndrome patients with and without diabetes mellitus.
Compared with nondiabetics, the group with diabetes experienced more recurrent ischemia, heart failure, cardiogenic shock, and ventilator requirement while in the hospital (). Mortality was numerically higher among the DM group compared with the non-DM group (2.7% versus 1.6%), but the difference in univariate analysis did not reach statistical significance (P = 0.105). Furthermore, diabetes status when evaluated as an independent risk factor for in-hospital mortality in ACS patients with adjustment for age and gender using multivariable logistic regression analysis, remained not statistically significant (OR 1.276, 95% CI 0.63–2.58, P = 0.497). From this analysis, the risk of in-hospital mortality increases by 3.5% for every year of age (OR 1.036, 95% CI 1.007–1.066, P = 0.016). In addition, our results showed that in-hospital mortality of males was less than half that of females, independent of DM status. This implies that women had a statistically significant adverse in-hospital outcome (death) than men (OR 0.423, 95% CI 0.186–0.962, P = 0.04).
In-hospital outcome in acute coronary syndrome diabetic and nondiabetic patients.