Patients with acute coronary syndrome with special reference to diabetes

mellitups
DR. AMRENDRA KUMAR SINGH1
DR. RAVI VISHNU PRASAD 2
INTRODUCTION
Ischemic heart disease (IHD) is a condition in which there is a inadequate supply of blood and oxygen to a
portion of the myocardium; it typically occurs when there is an imbalance between myocardial oxygen
supply and demand. Patients with ischemic heart disease (IHD) who most commonly present with stable
angina and with acute coronary syndrome 1.
Acute coronary syndrome which further separated into:-
 Acute myocardial infarctionwith ST segment elevation
 Acute myocardial infarction without ST segment elevation (NSTEMI)
 Unstable angina2.
Coronary artery disease (CAD) is the leading cause of death worldwide currently and together with
diabetes, it poses a serious health threat, particularly in Indian population
Risk factor includes abnormal cholesterols with elevated level of LDL- cholesterol and reduced level of HDL-
cholesterol, hypertension, cigarette smoking, Diabetes mellitus, male gender, post-menopausal
. .
1. M.B.B.S, M.D. (MEDICINE), Senior Resident Department of Cardiology, I.G.I.M.S. - Patna
2. M.D. , DM (CARDIOLOGY), Associate Professor Department of Cardiology, I.G.I.M.S. - Patna

state, advanced age, sedentary life style, obesity and a positive family history of premature cardiovascular
disease.
Diabetes mellitus is one of the major risk factor for acute coronary syndrome. Population with DM2 have a
2-3 times increase risk of cardiovascular disease than nondiabetics, and about 70% die from macro vascular
complications, especially ischemic heart disease and cerebrovascular disease. Approximately 20% of DM2
sufferers have vascular complications at the time of diagnosis.
AIMS AND OBJECTIVES
To interrogate and to assess the patients presented with acute coronary syndrome, for the presence of
conventional risk factors with special eye on diabetes.
MATERIALS AND METHOD
The present study was carried out in department of Cardiology IGIMS, Patna, on 65 patients of acute
coronary syndrome of both sex age more then 18 years were selected based on serial ECG changes and
Cardiac biomarkers then stratified accordingly into ST elevation MI, non ST elevation MI and unstable
angina. It is small scale retrospective study. Informed and written consent was taken from family members
of all these.
Inclusion Criteria
 Age ≥18 yrs.
 Patients with chest pain having ECG change & increased cardiac biomarkers.
Exclusion Criteria
 Patients with non cardiac chest pain
 without significant ECG changes
 without elevated cardiac biomarkers,
 Having previous ECG showing persistent elevated ST elevation.
INVESTIGATION
 Complete hemogram, blood sugar, urea, creatinine, lipid profile, routine examination of urine
 Chest x-ray
 Cardiac enzymes
 Electrocardiogram
 Echocardiography
 Coronary angiography
RESULTS:
Table number 1: Age distribution among study population
Age group (Years) Age distribution among study population
≤30 2
31-40 3
41-50 10
51-60 20
61-70 19
71-80 8
>80 3
Mean age among our study population was found to be 59.03 Years.
Table number 2: Distribtuion of BMI among study population
BMI DM Non DM
<25 16 17
25-30 26 4
>30 1 1

Table number 3: Distribution of lifestyle among study population

Lifestyle Patients distribution
Active 3
Sedentary 62

Table number 4: Distribution of Socioeconomic status among study population

 Socioeconomic status Status among study population
Upper 3
Middle 56
Lower 6

Table number 5: Distribution of smoking among study population

Smoking DM Non DM Total
Yes 30 17 47
No 13 5 18

Table number 6: Distribution of blood pressure among study population

hypertension Distribution of blood pressure among study population
Yes 47
No 18
Table number 7: Distribution of blood pressure among study population
Duration of blood pressure Distribution of blood pressure duration among
in years study population
<5 9
5-10 21
11-15 8
16-20 7
21-25 1
>25 1

Table number 8: Distribution of diabetes mellitus among study population

Diabetes mellitus Distribution of diabetes mellitus among study population
Yes 43
No 22

Table number 9: Distribution diabetes among study population

Durtion in years Duration of diabetes among study population
<5 14
3-10 17
11-15 7
16-20 4
>20 1

Table number10: Distribution of ACS among study population

Clinical subtype DM Non DM
ST elevation MI 29 13
Non ST elevation MI 4 4
Unstable angina 10 5
Total 43 22

Table number11: Distribution of dyslipidemia among study population

 Dyslipidemia DM Non DM
Present 36 3
Absent 7 19
Total 43 22

Table number12: Distribution of pattern of coronary artery involvement among study population
CAD pattern DM Non DM
SVD 15 9
DVD 17 10
TVD 2 3
Normal 7 0
Total 43 22
Not done in two patients
DISCUSSION
Total number of patients of acute coronary syndrome in this study was 65. Distribution pattern of different
clinical subtype of acute coronary syndrome were demonstrate as ST elevation MI constitute 65% of total
population followed by unstable angina 23% and non ST elevation MI 12%. All patients with ST elevation
and non ST elevation MI showed positive qualitative Troponin T test and increased levels of CPK and CPK-
MB.
Incidence of ACS increases as the age increases as shown by increased incidence of ACS in 5 th and 6th
decade. Mean age among our study population was found to be 59.03 Years. While mean age in CREATE
study was 57.5 years3
The obesity among our study population was found to be low (3%) and majority were with BMI below
25kg/m2 (51%). In study done by Diercks DB, roe MT, Mulgund J,Pollack CV, Kirk JD Jr.et al. found that most
(70.5%) of the CRUSADE patients were classified as obese or overweight (Overweight BMI 25-29.9 and
obesity BMI≥30.0) they present with co-morbid conditions like diabetes mellitus, hypertension and
hyperlipidemia4
In our study populationas the maximum patients was old age and retired they were having sedentary life
style compared to active life style with 95% and 5% respectively. Whereas in study done by Singh
RB,Sharma JP,Rastogi, V, Raghuvanshi RS,Moshiri M, Verma SP, et al. (1997) found that sedentary life style
was significantly higher in urban population compared to the rural subjects 5
Socioeconomic status in our study population was found to be maximum number of middle class then
lower followed by upper class as 56%, 9% and 5% respectively. In CREATE study most (52.5%) patients were
from lower-middle socioeconomic status6
There were 72% smokers and 28% were non smokers in our study population.
Among study population we found that 72% are hypertensive and remaining 28% are non hypertensive,
among hypertensive patients 9 patients were having hypertension for <5 years, 21 number of patients were
having it for 5-10 years, 8 patients having hypertension for 11-15 years and 7 patients were having
hypertension for about 16-20 years.
When we compared our population for the presence of diabetes mellitus we found that 66% are diabetic
and 34% were non diabetic, among diabetic patients 14 patients had diabetes for <5 years, 17 patient had
diabetes for 5-10 years and 7 patient had same for 11-15 years.
Among diabetes mellitus group of patients 68% were ST elevation MI,23% unstable angina and 9% were
non ST elevation MI versus in non diabetic population STEMI was 48% Unstable angina 37% and Non ST
elevation MI was 15%. As evident from number 24 diabetes mellitus increases the risk of STEMI. Among
diabetic population 84% were having dyslipidemia compared to 16% nonDyslipidemic and among
nondiabetic population 14% were Dyslipidemic compared to 85% nondyslipidemic.
Coronary angiography done on patient for the localization of lesion, among diabetic study population
sowed 35% with single vessel disease which include single vessel diffuse lesion, 39% patient with double
vessel disease, 5% patient with triple vessel disease and 21% patient with normal coronary angiogram, so it
indicates that diabetic patients can have ACS even in presence of normal coronary artery which might be
because of micro-vascular angina. In patients who suffered MI despite normal coronary angiogram,
smoking and diabetes are major risk factor 7. When we compared this distribution with non diabetic study
population it revealed that 41% are with single vessel disease, 45% with double vessel disease and 14% are
with triple vessel disease.
CONCLUSION
1. Majority of patients of ACS are with STEMI (65%)
2. Commonest risk factor in our population was hypertension (72%) and smoking (72%) followed by
dyslipidemia (68%), diabetes mellitus (66%) and obesity (46%)
3. STEMI was the commonest pattern of ACS in our diabetic population also (68%)
4. Presence of diabetes increases risk of dyslipidemia.
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