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Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease

  • Francisco Lopez-Jimenez
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA

    the Division of General Medicine and the Cardiovascular Division (FL, KEF, THL, PAJ), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
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  • Lee Goldman
    Affiliations
    Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA (LG). Dr. Paula Johnson is the recipient of a Minority Faculty Development Award from the Robert Wood Johnson Foundation. Dr. Fleischmann is the recipient of a Clinical Investigator Development Award (1KO8HL02964-01) from the National Heart, Lung, and Blood Institute
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  • Paula A Johnson
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA

    the Division of General Medicine and the Cardiovascular Division (FL, KEF, THL, PAJ), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
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  • Carı́si A Polanczyk
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA

    the Division of General Medicine and the Cardiovascular Division (FL, KEF, THL, PAJ), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA

    Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California, USA (LG). Dr. Paula Johnson is the recipient of a Minority Faculty Development Award from the Robert Wood Johnson Foundation. Dr. Fleischmann is the recipient of a Clinical Investigator Development Award (1KO8HL02964-01) from the National Heart, Lung, and Blood Institute
    Search for articles by this author
  • E.Francis Cook
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
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  • Kirsten E Fleischmann
    Affiliations
    the Division of General Medicine and the Cardiovascular Division (FL, KEF, THL, PAJ), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
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  • E.John Orav
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
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  • Thomas H Lee
    Correspondence
    Requests for reprints should be addressed to Thomas H. Lee, MD, Partners Community HealthCare, Inc, Suite 1150, Prudential Tower, 800 Boylston Street, Boston, Massachusetts 02119
    Affiliations
    Section for Clinical Epidemiology (FL, PAJ, CAP, EFC, EJO, THL), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA

    the Division of General Medicine and the Cardiovascular Division (FL, KEF, THL, PAJ), Brigham and Women’s Hospital, Harvard Medical School, and Partners Community HealthCare, Inc, Boston, Massachusetts, USA
    Search for articles by this author

      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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