Diabetic Patients and Their Presentation in Acute Coronary Syndrome With Outcomes: Does Gender Play Role?

Abstract

Objectives: To determine the frequency of different acute coronary syndrome (ACS) presentations and their outcomes in diabetic patients and gender based difference. Methodology: This cross sectional study was conducted in Cardiology Department of Khyber Teaching Hospital, Peshawar from 1st January to 31st July 2018. Diabetic patients admitted via emergency department presenting with acute coronary syndrome were included .The patients were followed during their hospital stay for complications like left ventricular failure, recurrent angina and mortality. All the variables were addressed according to gender difference. Chi-square test was used for final analysis. P< 0.05 was considered statistically significant. Results: A total of 388 diabetic patients were included. Of them males were 217 with mean age of 60.64 ± 9.24 years. About 65.46% patients presented to us with acute myocardial infarction. Thrombolytic therapy was done in 78.74% patients. About 86 males and 61 females developed symptoms of heart failure post MI (p < 0.001). In hospital mortality was found to be significant according to gender, p = 0.03. About 48.27% and 44.44% male patients presented with NSTEMI and USA respectively with no significant difference compared to females (p =0.21). However results were significant for stable angina [35.29% females vs. 64.70% males, p <0.001]. Conclusion: Diabetic patients present with coronary artery disease and its complications with heart failure and death more common among males as compared to females, needing special consideration for diagnosis and treatment.

Effect of Gender on the Outcome of Acute Coronary Syndrome in Type 2 Diabetes Mellitus

“…Our results concur with the aforementioned Pakistani study. 9 It similarly revealed that the risk of mortality is 2.58% in diabetic males and 1.58% in females, which is again in correspondence with our analysis regarding the mortality rate of CAD in diabetic patients based on gender. Our single-centrebased study was conducted on most patients who were uneducated about their condition and unaware of maintaining a proper medical history of their cardiovascular disease.…”

“…Another institute in Pakistan reported an almost similar pattern in their ndings. 9 Regarding the outcomes of CAD, there was a significant gender-wise dierence. Congestive heart failure was observed in 43.9% of males and 22.4% of females, re-angina was observed more in the female patients as compared to the male patients (19.3% vs 40.8%) and mortality was higher in the male patients as compared to female patients (15.8% vs 4.1%).…”

“…Some studies suggest that while the probability of having CVD nearly doubles in men, it is four times more likely in females with diabetes. 9,10 The fact may be that diabetic women experience CVD at a later stage than non-diabetic women, making their CVD risk comparable to that of diabetic men. Moreover, young diabetic women are reported to be at greater risk.…”

Comparison of Clinical and Angiographic Characteristics of Diabetic and Non-Diabetic Patients With Acute Myocardial Infarction

“…Increased incidence of adverse outcomes among diabetic patients after PCI is well reported by various other studies as well. 9,[17][18][19] Further multi-center large-scale studies are required in our population to highlight the clinical importance and impact of diabetes mellitus on the clinical course and prognosis of STEMI patients. Even though this study was performed at the largest cardiac care center of the country, single-center coverage and a limited number of study subjects remained the main limitation of this study.…”