A Comparative study on the Clinical Profile and Outcome of ST-Elevation Myocardial Infarction among Diabetic and Non-Diabetic South Indian Patients

Suresh, Davis (2007) A Comparative study on the Clinical Profile and Outcome of ST-Elevation Myocardial Infarction among Diabetic and Non-Diabetic South Indian Patients. Masters thesis, Kilpauk Medical College, Chennai.

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Abstract

INTRODUCTION Heart disease was thought to be associated with diabetes as early as 1883, when Vergeley recommended testing the urine of patients with angina for glucose. However, as more patients with diabetes survived following the discovery of insulin and improvements in the treatment of renal failure and infection, there was a marked increase in morbidity and mortality from cardiovascular disease. Diabetes mellitus is a strong risk factor for cardiovascular disorders, including coronary heart disease. In previous studies, diabetes mellitus has been diagnosed in 10 to 24% of patients with acute myocardial infarction. Furthermore, the age-adjusted prevalence of diabetes among patients with acute myocardial infarction has increased significantly over the past two decades. A true increase in diabetes, improved documentation in medical records and longer survival of diabetic patients are all factors underlying this increase. Patients with diabetes and myocardial infarction were older and more likely to be females. They present more with anterior wall myocardial infarction, to receive thrombolysis later and to have triple-vessel coronary artery disease. They have more severe coronary artery disease and poor left ventricular ejection fraction, Diabetes mellitus is an independent predictor for mortality after myocardial infarction and a two to fourfold increase in mortality due to coronary artery disease was noted among diabetics. American Heart association AHA has recently stated that “diabetes is a cardiovascular disease”. AIMS AND OBJECTIVES 1. To study the influence of diabetes on the age of occurrence of STEMI. 2. To study the gender distribution among Diabetic and Nondiabetic patients with STEMI. 3. To study the incidence of painless STEMI in Diabetic and Nondiabetic patients. 4. To study the influence of diabetes on the principal region of myocardial involvement in STEMI. 5. To study the influence of diabetes on complications of STEMI. 6. To evaluate the influence of diabetes on in-hospital mortality in STEMI patients. MATERIALS AND METHODS: A randomised comparative study and analysis with patients drawn from Intensive coronary care unit. Study Population: The study was conducted over a 2 year period from June 2004 to June 2006. Cases were drawn from Intensive coronary care unit, Department of Cardiology, Kilpauk Medical College. Informed consent was taken from all participants of the study. The clinical profiles of patients admitted with ST elevation MI (STEMI) were analyzed. The patients were grouped into diabetics and nondiabetics based on their previous history of diabetes. A total of 2113 patients were initially chosen for the study. 671 were found to be diabetic and the remaining 1442 were nondiabetic. On application of exclusion criteria, 458 and 1036 patients were excluded from the diabetic and nondiabetic group respectively. Eight of the 113 diabetic patients and 14 among the 406 nondiabetic patients expired as a result of cardiogenic shock soon after admission. 9 and 6 patients expired due to other complications of acute myocardial infarction in the diabetic and nondiabetics groups respectively. In the above patients blood sugar values and echo evaluation could not be performed. Inclusion Criteria: Patients with STEMI evidenced by ECG and clinical symptoms <24 hrs Patients with age above 20 years were chosen for the study. Exclusion Criteria: • Patients with previous history of hypertension. • Patients with previous history of MI. DISCUSSION: Out of the 519 cases of myocardial infarction in this study, 113 cases were diabetics and 406 cases were non diabetics. There were 7 cases of myocardial infarction under the age of 30 years in the non diabetic group compared to none in the diabetic group. Between 31 to 50 years the incidence of myocardial infarction was more common in the non diabetic group compared to diabetic group. Above the age of 50 years the incidence of myocardial infarction was higher in the diabetic population. Even though there was a slight increase in the age of occurrence of myocardial infarction among the diabetic patients compared to nondiabetics, it was not statically significant. Percentage of female patients with myocardial infarction in the diabetic group was 29.20% when compared to 16.25% in non diabetic group. This is well in correlation with study of Stone P H et al (14). 42.8% of the patients in the diabetic group had sedentary life style compared to 27.5% of patients in non diabetic group. SUMMARY: The present study was conducted over a period two years among patients admitted with ST elevation myocardial infarction in the cardiology department of Kilpauk Medical College. Patients were divided into diabetic and non diabetic groups. With application of inclusion as well as exclusion criteria 113 diabetics and 406 nondiabetics were chosen for the study. Findings of the study are as follows: 1. There was no significant difference in the age of occurrence of myocardial infarction among diabetic and non diabetic group (p value > 0.05). 2. The percentage of females in diabetic group were far more compared to non diabetic group. (diabetic =29.20%, non diabetic =16.25%). 3. The diabetic group had more sedentary life style compared to non diabetics. (diabetic =42.48%, non diabetic =27.40%). 4. Painless myocardial infarctions were 7 times more common in diabetic group. (odds ratio = 7.16) (P value < 0.001). 5. Most of the patients in the diabetic group were detected to have diabetes over the last five years (61.95 %). 6. Diabetic patients with myocardial infarction showed a preponderance to anterior wall compared to non diabetics. (Odds ratio = 3.79). 7. Cardiac failure was about six times more common in the diabetic group (Odds ratio = 5.83) (P<0.001). 8. Complications of myocardial infarctions were also common in diabetic group (ventricular arrhythmia- odds ratio = 4.40, complete heart block) (P<0.001). 9. Mortality due to myocardial infarction in diabetic group was about four times that of non diabetic group. (odds ratio = 3.42). 10. No significant time difference in receiving thrombolysis was noticed in the two groups (P>0.05).

Item Type: Thesis (Masters)
Uncontrolled Keywords: Clinical Profile and Outcome ; ST-Elevation Myocardial Infarction ; Diabetic ; Non-Diabetic South Indian Patients ; Comparative study.
Subjects: MEDICAL > General Medicine
Depositing User: Subramani R
Date Deposited: 10 Mar 2018 03:56
Last Modified: 10 Mar 2018 04:02
URI: http://repository-tnmgrmu.ac.in/id/eprint/6113

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