Comparison of Clinical Presentation of Acute Coronary Syndrome in Diabetic Vs Non-Diabetic Patients

Background: Diabetes mellitus (DM) is one of the major risk factors of acute coronary syndrome (ACS). There are certain differences reported in clinical presentation of patients with ACS between diabetic and non-diabetic patients. Objective: To compare the clinical profile and symptoms experienced by diabetic and non-diabetic patients of ACS. Methodology: A descriptive cross-sectional survey was conducted among 60 diabetic and 60 non-diabetic patients hospitalized with ACS in atertiary care centre, Delhi. The sample size of 120 i.e. 60 in each diabetic and non- diabetic group, was statistically calculated. Patients were enrolled only if they were hemodynamically stable and did not have any cognitive dysfunction or communication disability. Consent was obtained from patients after explaining the objectives of the study. Data on patient as well as clinical profile and initial symptoms of ACS were collected using structured interview. Results: The mean age of the patients with DM was 64.23+14.7years and without DM was 64+13.1years. Majority of the patients in both groups were males, married, belonged to nuclear family and were from urban setting. When 56.67% of diabetic patients were employed, 63% of non-diabetic patients were retired (p=0.001). Two third of the patients were diagnosed to be diabetic for more than one year. Majority of the patients who were on treatment were receiving oral hypoglycemic agents. As compared to non-diabetic patients of ACS, more number of diabetic patients with ACS were found to have high cholesterol level, alcoholism, family history of CAD, previous history of ACS, history of CABG and endovascular coronary interventions. Significantly higher number of diabetic patients i.e,83.3% were found to have STEMI as compared to 38.3% in non-diabetic patients. Cardiac enzymes were elevated in 90% of the diabetic patients as compared to 55% of non-diabetic patients (p=0.001). When 86.7% of nondiabetic patients experienced chest pain as one of the initial symptom of ACS, only 20% diabetic patients experienced the same in non-diabetic patients(p=0.001). Among prevalent symptom of ACS, chest pain, cold sweat, nausea/vomiting and palpitation were reported by significantly higher number of non-diabetic patients. significantly higher number of diabetic patients reported shortness of breath/ dyspnea, gastric discomfort, unusual fatigue, anxiety, syncope/giddiness and headache. While, significantly more number of non-diabetic patients reported pain in shoulders and arms. Significantly more number of diabetic patients reported jaw pain and neck pain. Conclusion: As per the present study findings, chest pain is less prevalent as an initial symptom of ACS in patients of diabetes and the diabetic patients may experience various atypical symptoms other than chest pain during ACS. Dyspnea, syncope/ giddiness were the major symptoms experienced by diabetic patients during ACS as compared to non-diabetic patients. Appropriate measures must be taken for diabetic patients by the health care providers to facilitate early and adequate management of ACS.