Author + information
- Jonathan Evans,
- Tigran Khachatryan,
- David Hamilton,
- Andrew Stewart,
- Daniel Amponsah,
- Eric Suh,
- Kenneth Jutzy,
- Islam Abudayyeh and
- Anthony Hilliard
Background: Worldwide, the annual number of people diagnosed with diabetes continues to increase. Classically, Diabetes Mellitus (DM) has been associated with silent or atypical initial symptoms and increased time to presentation in patients presenting with ST elevation myocardial infarction (STEMI) compared to non-DM patients. It is less clear whether the type of treatment or the adequacy of glycemic control impacts the time to presentation and type of symptoms. Therefore, we sought to evaluate the impact of poor glycemic control on these outcomes as measured by hemoglobin A1c.
Methods: In this retrospective study, we evaluated data from 766 patients who presented to a tertiary-care university medical center with STEMI from 2008-2015. Over that timeframe, 238 of the 766 patients who presented with STEMI had DM. T-test, X2 test, and regression analysis were used for statistical analysis and comparison of the groups.
Results: Diabetic patients presenting with STEMI on average presented 50 minutes later than non-diabetic patients (194.8 minutes vs. 144.7 minutes, p = 0.0054). Furthermore, time to presentation increased for every unit increase in hemoglobin A1c level (p = 0.0035). Hospital length of stay was significantly longer in DM vs non-DM patients (3.37 v 2.87 days, respectively, p = 0.011). However, there was no significant difference in initial troponin level between the two groups (2.02ng/mL v 2.17ng/mL in DM v non-DM, respectively, p = 0.59). Chest pain was the most common presenting symptom in diabetic and non-diabetic patients with similar rates in both groups (87.4% v 89.1%, p = 0.561). No statistically significant difference was found in rates of shortness of breath, syncope, or GI symptoms between the two groups.
Conclusions: Diabetic patients have delayed time to presentation and longer hospital length of stay compared to non-diabetic patients with STEMI. Additionally, the worse the glycemic control the longer the time to presentation. However, in contrast to prior observations, both diabetic and non-diabetic patients presented with similar rates of chest pain.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m
Session Title: Traditional and Novel Factors Used to Assess the Risk of, and Used for the Treatment of, Coronary Artery Disease
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1126-322
- 2017 American College of Cardiology Foundation