Author + information
- Jeremy Ben-Shoshan,
- David Zahler,
- Yafit Segman-Rosenstveig,
- Yaron Arbel,
- Ehud Chorin,
- Michael Barkagan,
- Zach Rozenbaum,
- Yoav Granot,
- Ariel Finkelstein,
- Shmuel Banai,
- Gad Keren,
- Yacov Shacham and
- Maayan Konigstein
Background: Multiple physical, emotional, and extrinsic triggers have been attributed to acute coronary syndrome (ACS) yet, the relation of such triggers to the nature and extent of coronary artery disease (CAD) remains unclear. Diabetic patients often experience ACS with atypical presentation adding complexity to clinical assessment. We therefore evaluated the predictive value of identifiable triggers among diabetic ST-Segment Elevation Myocardial Infarction (STEMI) patients treated with primary percutaneous coronary intervention (PCI).
Methods: We conducted a retrospective, single-center observational study including 284 consecutive diabetic patients with STEMI undergoing PCI. Acute physical and emotional triggers were identified and recorded from patients’ historical data. The significance of potential prognostic factors on the extent of CAD was studied by univariate and multivariate logistic regression models. Survival rates were obtained by Kaplan–Meier method.
Results: A potential trigger was identified in 30% of patients. Physical exertion was the most dominant trigger (62%) followed by psychological stress (15%) and acute illness (15%). Patients with non-triggered STEMI were older (66±11y vs 60±11y, p<0.001) and had higher prevalence of multivessel coronary artery disease (CAD), compared to triggered-STEMI patients (76% vs 39%, respectively, p<0.001). In a multivariate logistic regression model, non-trigged STEMI emerged as a strong, independent predictor of multivessel CAD (OR 4.35, 95% CI 2.48-7.62, p<0.001). During a median follow-up of 4.6 ± 2.1 years, 46 patients died. Kaplan-Meier analysis revealed significantly lower survival rates for patients with non-triggered STEMI as compared to triggered-STEMI patients (log Rank test p=0.013).
Conclusions: Symptom onset without a recognizable trigger among diabetic STEMI patients predicts disease extent and is associated with lower post-interventional survival. The present study emphasizes the importance of instantaneous anamnestic evaluation of symptoms, for primary assessment of CAD severity and prognosis of diabetic STEMI patients.
Poster Hall, Hall C
Saturday, March 18, 2017, 9:45 a.m.-10:30 a.m.
Session Title: Cardiac Arrest, Diabetes, and Other High Risk Features of Patients With Acute Coronary Syndrome
Abstract Category: 2. Acute and Stable Ischemic Heart Disease: Clinical
Presentation Number: 1204-330
- 2017 American College of Cardiology Foundation