Abstract

Introduction: Coronary artery disease is an important cause of mortality in India, accounting for about more than 25% of deaths. About 1/3rd of the acute coronary syndrome patients had diabetes mellitus.⁽¹⁾ Most of the patients were above 50 years of age with 13.3% above 70 years. Diabetes mellitus leads to dysfunction of vascular endothelium and accelerated atherosclerosis. Diabetes increases the risk of developing coronary artery disease by 2-4 folds.⁽²⁾ The risk of developing an acute coronary syndrome and of death after an acute myocardial infarction is increased among patients with CAD when associated with Diabetes. Complications and mortality due to acute myocardial infarction are more in the elderly than the young. The late seeking of medical care in cases of diabetics is also a factor.

Aim of the Study: To study the differences, if any, in the presentation of Acute Myocardial Infarction in Elderly Diabetic and Non–Diabetic patients.

Materials and Methods: This study was conducted in Tamil Nadu Government Multi Super Speciality Hospital, Omandurar Government Estate, Chennai. from January 2018 to December 2019 (24 months)100 Patients admitted to the Intensive Cardiac Care Unit, Cardiac were included in the study. Persons satisfying the inclusion criteria were assessed based on history, clinical examination, ECG changes, cardiac biomarkers, and diabetic status.  Patients will be followed up 30 days after discharge.

Results: 64 patients were male and 36 female. 24 (24%) of them were diabetic.13 (20.31%) of the males and 11 (30.56%) of the females had diabetes mellitus. 82 (82%) patients presented with chest pain, while 18 (18%) reported no chest pain. 47 (57.32%) patients had chest pain lasting more than 4 hours, of whom 10 (21.28%) were diabetic. 35 patients (45.12%) presented within 4  hours of the onset of chest pain. Of them, 8 (22.86%) were diabetic. There was no significant difference between the two (p = 0.86). 52 patients presented with radiation of chest pain. 11 (21.15%) were diabetic. 41 were non-diabetic (78.85%). There was no significant difference between the two groups. (p = 0.81). Out of 37 patients who had inferior wall myocardial infarction 9 were diabetic. 17 patients had combined inferior and posterior wall myocardial infarction. 5 of them were diabetic. 1 out of the 9 cases of lateral wall myocardial infarction was diabetic. There was a single case of new-onset left bundle branch block. Of the 93 cases of ST-elevation myocardial infarction, 84 were thrombolysed. Door to needle time was less than 30 minutes in 40 (47.62%) cases. Of the 18 diabetics who were thrombolysed, door to needle time was less than 30 minutes in 8 (44.44%) patients. There was no significant difference indoor to needle time in diabetic and non-diabetic patients. (p-value = 0.76).

Conclusion: According to the current study, hyperglycemia has a substantial impact on in-hospital course in both diabetic and non-diabetic patients. In diabetic patients particularly, hyperglycemia was independently predictive of in-hospital death. In diabetic patients, admission serum glucose level has a good predictive value for in-hospital death.

Keywords: Coronary Artery Disease, Diabetes Mellitus, Diabetic Keto Acidosis, American Diabetes Association.