Abstract
PURPOSE: Patients with diabetes and acute chest pain may be admitted to hospitals
more frequently than patients without diabetes because physicians suspect atypical
presentations for ischemic heart disease. This study aimed to determine whether the
presentation of acute myocardial infarction and risk for major cardiac complications
differs among patients without known coronary artery disease who do or do not have
diabetes.
PATIENTS AND METHODS: Data from an emergency department of an urban teaching hospital
on the medical histories, physical examinations, and electrocardiograms of 2,694 subjects
with acute chest pain and without known coronary artery disease were prospectively
recorded.
RESULTS: Diabetes was present in 301 (11%) patients. Compared with patients without
diabetes, patients with diabetes were more likely to be ≤60 years old (51% versus
20%) and to have a history of hypertension (70% versus 35%) or high blood cholesterol
(35% versus 19%). A discharge diagnosis of acute myocardial infarction was made in
25 diabetic (8%) and in 148 nondiabetic (6%; P = 0.16) patients. A major cardiac complication occurred in two patients with diabetes
(0.7%) and in 20 patients without diabetes (0.8%; P = 1.0). Patients with and without diabetes who had atypical chest pain complaints
had similar rates of myocardial infarction (3% and 4%, respectively; P = 0.6). Patients with diabetes were more likely to be hospitalized (67% versus 47%;
P = 0.001) both before and after adjusting for clinical and electrocardiographic data.
CONCLUSIONS: For patients with acute chest pain without a prior history of coronary
artery disease, diabetes was not associated with a higher rate of acute myocardial
infarction or complications. However, diabetes was associated with a higher rate of
hospitalization in this population, suggesting that physicians have a lower threshold
for admission to the hospital of patients with diabetes.
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Article Info
Publication History
Accepted:
July 13,
1998
Received in revised form:
July 13,
1998
Received:
December 15,
1997
Identification
Copyright
© 1998 Excerpta Medica Inc. Published by Elsevier Inc. All rights reserved.
