Diabetic patients with an acute myocardial infarction in terms of risk factors and comorbidities management: Characteristics of the highest-risk individuals

Abstract

Background. Patients with diabetes mellitus (DM) and acute myocardial infarction (AMI) are heterogeneous individuals with different clinical status compared to patients without DM. Objectives. The aim of this study was to analyze the group of diabetic patients with ST-segment elevation MI (STEMI) or non-ST-segment elevation infarction (NSTEMI) including risk factors, medical history, laboratory findings, advancement of coronary vessel atherosclerosis, and diagnostics and therapeutic modalities performed. A comparison of groups according to the type of MI was also made. Material and Methods. The study involved all (n = 130) patients with DM and AMI, hospitalized in the Department of Cardiology, Medical University of Silesia, Katowice, in 2012. Clinical presentation, medical history, laboratory tests, imaging studies and additional tests as well as treatment management data were collected. Statistical analysis of the data obtained was performed using STATISTICA® software. Coronary angiography was performed in 120 subjects (92.3%). Results. NSTEMI almost doubled STEMI occurrence in the study group (65.4% vs. 34.6%). Left main disease (LMD) was more often diagnosed in the NSTEMI subgroup of patients (14.1% vs. 6.7%). There were no significant differences between the compared groups as far as clinical presentation and comorbidities are concerned; more frequent previous PCI in NSTEMI patients was noticed, however (37.7% vs. 17.8%; p = 0.0195). The STEMI subgroup was characterized by higher leukocytosis (13.2 vs. 10.0 × 103/μL; p < 0.001) and serum glucose concentration (217 vs. 182 mg%; p = 0.001); they were also treated with invasive methods more frequently (95.5% vs. 75%; p < 0.001) and the left anterior descending artery was delivered with stents more frequently (63.3% vs. 48.7%; p = 0.0426). Conclusions. Patients with DM and AMI are burdened with metabolic disorders and numerous risk factors. They require aggressive diagnostics and therapy including new revascularization techniques and optimal medical treatment. Regardless of the type of AMI (STEMI or NSTEMI), the study group was homogeneous in terms of complaints, comorbidities and metabolic profile.