ABSTRACT
Abstract ................................................................................................. 432 11.1 Introduction ................................................................................ 433 11.2 Materials and Methods ............................................................... 438
11.2.1 Statistical Analysis ......................................................... 439 11.3 Discussion .................................................................................. 440 11.4 Results ........................................................................................ 443 11.5 Conclusion ................................................................................. 444 Keywords .............................................................................................. 445 References ............................................................................................. 445
ABSTRACT
The coronary heart disease (CHD) is common in people with diabetes mellitus (DM). In people with diabetes, CHD causes almost 60% of their deaths. They have a two-to three-fold increased risk for CHD and two-to four-fold higher CHD morbidity and mortality rates. Diabetic patients with myocardial infarction (MI) have a two-to three fold higher mortality than do their non-diabetic counterparts. The most important factor for this is increased left ventricular failurewhich may be due to a “diabetic cardiomyopathy” that is not related to the atherosclerosis. Another possible factor is the higher prevalence of silent ischemia that can lead to delayed diagnosis of CHD in people with diabetes.Diabetic patients with MI also have worse long-term prognosis than do their non-diabetic counterparts. The present observational and prospective study was conducted in the intensive care unit of a tertiary care centre and Government Medical College, Nanded. The aim of this chapter was to study the prevalence of DM in patients presenting with acute myocardial infarction (AMI). The objectives of this study were to compare clinical outcome in diabetic versus non diabetic patients with AMI, to study the role of some risk factors in AMI patients associated with DM. All the patients presenting with AMI admitted in the Intensive Cardiac Care Unit (ICCU) from July 2011 to January 2012 were studied. Patients were diagnosed to have DM as per American Diabetes Association (ADA) Guidelines. Study population was divided into two groups, patients having diabetes and not having diabetes. Detail present, past, and family history along with clinical examination of every patient was collected and entered in a performa prepared specially for collection of data. Glycosylated hemoglobin was not done due to non-affordability of patients, being a resource limited setting. Consecutive patients having ST elevation MI (As per World Health Organization criteria) who were treated with Streptokinase at the time of admission in MICU were included in the study. Patients coming after 12 hr of chest pain and patients suffering from type 1 diabetes mellitus (T1DM) were excluded from the study. A total of 176 patients were included in the study. One hundred thirty three were male and 43 females. In diabetics 71 (78.7%) out of 91 patients (p< 0.0001) and in non-diabetics 28 (33.2%) out of 85 patients developed complications during their ICCU stay. Diabetics have more complications
as compared to non-diabetics, recurrent chest pain (64.1% versus 33.1%, p< 0.0001), heart failure (36.6% versus 18.82%, p< 0.0001), arrhythmias (43.6% versus 17.6%, p< 0.0001), and mortality (4.3% versus 1.17%, p< 0.05). Smoking (42.1%) and alcohol consumption (56.5%) were found to be significant in diabetic group as compared to the non-diabetic group. Hypertension was found more common in diabetic (p< 0.05) as compared to non-diabetic study population.
