Introduction: This study aimed to compare the frequency of diabetic and non-diabetic patients admitted for ST-elevation myocardial infarction (STEMI), assess their epidemiological, clinical, and paraclinical profiles, and evaluate their therapeutic strategies and outcomes. Methodology: A descriptive, analytical, comparative study with prospective and retrospective data collection was conducted from April 1, 2020, to March 31, 2021. Diabetic and non-diabetic patients with STEMI admitted to a cardiology department were included. STEMI diagnosis was based on clinical and electrocardiographic criteria showing persistent ST-segment elevation in at least two leads. All patients included in the study signed a written, informed consent form. Data analysis was performed using SPSS, with a p-value ≤ 0.05 considered statistically significant. Results: STEMI prevalence was 15.27%, with 37.11% of patients being diabetic and 62.89% non-diabetic. Diabetic patients had a mean age of 59.2 ± 10.9 years, while non-diabetics averaged 58 ± 13.4 years. Diabetics were predominantly female (72.2%), whereas non-diabetics were mainly male (83.6%). Smoking was less frequent among diabetics (25% vs. 47.54%), but hypertension, obesity, and sedentary lifestyle were more common. Diabetics had an average of 3.5 ± 1.1 risk factors compared to 2.6 ± 1.2 in non-diabetics. Admission delay was longer for diabetics (34.8 ± 51.6 hours vs. 23.3 ± 52.3 hours). Chest pain was the main symptom in both groups. Electrocardiograms showed that anterior and inferior infarctions were most frequent. Triple vessel disease and severe complications, such as cardiogenic shock, were more common in diabetics, who also had higher mortality (5.56% vs. 3.28%). Conclusion: Diabetic STEMI patients represent a high-risk group with distinct clinical features, longer admission delays, and a greater accumulation of cardiovascular risk factors, emphasizing the need for targeted interventions.
References
[1]
Hampton, J. and Gray, A. (1998) The Future of General Medicine; Lesson from an Admission Ward. The Journal of the Royal College of Physicians, 32, 39-43.
[2]
Iqbal, M.J., Azhar, M., Javed, M.T. and Tahira, I. (2008) Study on ST-Segment Elevation Acute Myocardial Infarction (STEMI) in Diabetic and Non-Diabetic Patients. Pakistan Journal of Medical Sciences, 24, 786-791.
[3]
Wild, S., Roglic, G., Green, A., Sicree, R. and King, H. (2004) Global Prevalence of Diabetes: Estimates for the Year 2000 and Projection for 2030. Diabetes Care, 27, 1047-1053. https://doi.org/10.2337/diacare.27.5.1047
[4]
Boyle, J.P., Honeycutt, A.A., Narayan, K.M.V., Hoerger, T.J., Geiss, L.S., Chen, H., et al. (2001) Projection of Diabetes Burden through 2050: Impact of Changing Demography and Disease Prevalence in the US. Diabetes Care, 24, 1936-1940. https://doi.org/10.2337/diacare.24.11.1936
[5]
Tschöpe, D. (2006) Diabetiker in der Sekundärprävention. Clinical Research in Cardiology, 95, vi23-vi27. https://doi.org/10.1007/s00392-006-1805-5
[6]
Dirkali, A., van der Ploeg, T., Nangrahary, M., Cornel, J.H. and Umans, V.A.W.M. (2007) The Impact of Admission Plasma Glucose on Long-Term Mortality after STEMI and NSTEMI Myocardial Infarction. International Journal of Cardiology, 121, 215-217. https://doi.org/10.1016/j.ijcard.2006.08.107
[7]
Pitsavos, C., Kourlaba, G., Panagiotakos, D.B. and Stefanadis, C. (2007) Characteristics and In-Hospital Mortality of Diabetics and Nondiabetics with an Acute Coronary Syndrome; the GREECS Study. Clinical Cardiology, 30, 239-244. https://doi.org/10.1002/clc.20078
[8]
Laing, S.P., Swerdlow, A.J., Slater, S.D., Botha, J.L., Burden, A.C., Waugh, N.R., et al. (1999) The British Diabetic Association Cohort Study, II: Cause-Specific Mortality in Patients with Insulin-Treated Diabetes Mellitus. Diabetic Medicine, 16, 466-471. https://doi.org/10.1046/j.1464-5491.1999.00076.x
[9]
Lindeman, R.D., Romero, L.J., Hundley, R., Allen, A.S., Liang, H.C., Baumgartner, R.N., et al. (1998) Prevalences of Type 2 Diabetes, the Insulin Resistance Syndrome, and Coronary Heart Disease in an Elderly, Biethnic Population. Diabetes Care, 21, 959-966. https://doi.org/10.2337/diacare.21.6.959
[10]
Danaei, G., Lawes, C.M., Vander Hoorn, S., Murray, C.J. and Ezzati, M. (2006) Global and Regional Mortality from Ischaemic Heart Disease and Stroke Attributable to Higher-Than-Optimum Blood Glucose Concentration: Comparative Risk Assessment. The Lancet, 368, 1651-1659. https://doi.org/10.1016/s0140-6736(06)69700-6
[11]
Zhou, C. and Byard, R.W. (2017) An Analysis of the Morbidity and Mortality of Diabetes Mellitus in a Forensic Context. Journal of Forensic Sciences, 63, 1149-1154. https://doi.org/10.1111/1556-4029.13674
[12]
Einarson, T.R., Acs, A., Ludwig, C. and Panton, U.H. (2018) Prevalence of Cardiovascular Disease in Type 2 Diabetes: A Systematic Literature Review of Scientific Evidence from across the World in 2007-2017. Cardiovascular Diabetology, 17, Article No. 83. https://doi.org/10.1186/s12933-018-0728-6
[13]
Punthakee, Z., Goldenberg, R. and Katz, P. (2018) Definition, Classification and Diagnosis of Diabetes, Prediabetes and Metabolic Syndrome. Canadian Journal of Diabetes, 42, S10-S15. https://doi.org/10.1016/j.jcjd.2017.10.003
[14]
Byrne, R.A., Rossello, X., Coughlan, J.J., Barbato, E., Berry, C., Chieffo, A., et al. (2023) 2023 ESC Guidelines for the Management of Acute Coronary Syndromes. European Heart Journal, 44, 3720-3826. https://doi.org/10.1093/eurheartj/ehad191
[15]
Tipoo, F.A., Quraishi, A.R., Najaf, S.M., Kazmi, K.A., Jafary, F., Dhakam, S., et al. (2004) Outcome of Cardiogenic Shock Complicating Acute Myocardial Infarction. Journal of College of Physicians and Surgeons Pakistan, 14, 6-9.
[16]
Esteghamati, A., Abbasi, M., Nakhjavan, M., Yousefizadeh, A., Basa, A.P. and Afshar, H. (2006) Prevalence of Diabetes and Other Cardiovascular Risk Factors in an Iranian Population with Acute Coronary Syndrome. Cardiovascular Diabetology, 5, Article No. 15.
[17]
Abid, A.R., Malick, N.H., Shahbaz, A. and Tarin, S.M.A. (2005) In-Hospital Outcome of Acute Myocardial Infarction (ST Segment Elevation Type) in Diabetics and Non-Diabetics. Journal of College of Physicians and Surgeons Pakistan, 15, 524-527.
[18]
Atmaca, A., Gogan, S., Dagdele, S., Kabakci, G., Kes, S., Nazli, N., et al. (2006) Management and In-Hospital Outcome of Patients with First Episode of Acute Myocardial Infarction: Impact of Diabetes Mellitus. Journal of the National Medical Association, 98, 1752-1757.
[19]
Iqbal, M.J., Javed, M.T. and Tahira, I. (2011) Complication and Mortality in ST-Segment Elevation Acute Myocardial Infarction in Diabetic and Non-Diabetic Patients. Medical Journal of Islamic World Academy of Sciences, 19, 87-94.
[20]
Comtois, R., Lemay, C. and Laliberte, A. (1995) Coexistence of Hypothyroidism and Myocardial Infarction. Canadian Journal of Cardiology, 11, 37-42.
[21]
Čulić, V., Mirić, D. and Jukić, I. (2003) Acute Myocardial Infarction: Differing Pre-Infarction and Clinical Features According to Infarct Site and Gender. International Journal of Cardiology, 90, 189-196. https://doi.org/10.1016/s0167-5273(02)00563-6
[22]
Jaski, B.E., Cohen, J.D., Trausch, J., Marsh, D.G., Bail, G.R., Overlie, P.A., et al. (1992) Outcome of Urgent Percutaneous Transluminal Coronary Angioplasty in Acute Myocardial Infarction: Comparison of Single-Vessel versus Multivessel Coronary Artery Disease. American Heart Journal, 124, 1427-1433. https://doi.org/10.1016/0002-8703(92)90053-x
