Arshad Naseem, Shaheen Moin.
Comparison of Diabetics and Non-Diabetics presenting with acute Myocardial Infarction.
J Coll Physicians Surg Pak Jan ;12(6):356-60.

Objective: To identify differences in incidence and clinical manifestations of acute myocardial infarction (AMI) and prevalence of coronary disease risk factors in diabetic and non-diabetics. Design : A prospective longitudinal survey. Place and Duration of Study: The study was carried out in Armed Forces Institute of Cardiology/National Institute of Heart Diseases (AFIC/NIHD) Rawalpindi, over a period of one month (1st August to 1st September, 1994). Subjects and Methods: After fulfilling the inclusion criteria, a total of 100 patients were included in the study. Fifty patients had diabetes and AMI while 50 patients had AMI but were not diabetic. All the patients were studied for at least 15 days in hospital and data collected on a pre-designed proforma. Results: Among diabetic patients, 84% were not insulin-dependant, while remaining 16% were on insulin therapy. Duration of diabetes was over 20 years in 18%, between 10 and 20 years in 62% and less than 10 years in 8%. Male to female ratio was 7.3:1 in non-diabetic group while in diabetic group it was 4.5:1. Mean age at the time of the first AMI was 54.6 years in non-diabetic group and 52.8 years in diabetic group, with women in diabetic group having mean age of 51.9 years, men 53.2 years, while non-diabetic women had a mean age of 54.2 years and the men 55 years. Incidence of hypertension was 32% among diabetic patients and 24% among non-diabetics. Lipid abnormalities were 44% in diabetic group and 36% in non-diabetic group. The most common mode of presentation in both groups was chest pain or chest discomfort, but one-fourth of the diabetics presented without any chest pain. Q-wave AMI of the anterior wall of the myocardium predominated in both groups, but non-Q wave infarctions were more frequent in the diabetic group (28% vs. 16%). Diabetic group tended to be identified later and only half the diabetics with AMI qualified for thrombolytic therapy as compared to more than 2/3 cases of the non-diabetic group. Hospital mortality (two weeks), was 14.9% in diabetic men and 11.3% in non-diabetic men, while comparative mortality was 22.2% in diabetic women and 16.6% in non-diabetic women. Conclusion: Diabetic subjects, especially diabetic women with coronary risk factors for AMI carefully monitored and treated more aggressively if primary prevention of coronary artery disease (CAD) is to be as effective as in the non-diabetic population in whom the incidence of AMI and more significantly, mortality from CAD has declined in the last 35 years.

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