Clinical profile of patients with acute coronary syndrome with special reference to diabetes mellitus

Vinod Wasudeo Chahare, Tapas Ray, Chandramouli Bhattacharya, Abhinav Dileep Wankar


Background: Ischemic heart disease is defined as inadequate blood flow resulting in decreased oxygenation to the myocardium due to severe narrowing and/or complete blockage of coronary arteries. Although a number of risk factors have been identified over the past several decades, the precise aetiology and mechanisms leading to the development of CAD are not fully understood. These includes abnormal levels of circulating cholesterols with elevated level of LDL-cholesterol and reduced level of HDL-cholesterol, hypertension, cigarette smoking, diabetes mellitus, male gender, post-menopausal state, advanced age, sedentary life style, obesity and a positive family history of premature cardiovascular disease female population.

Methods: Our study was aimed to interrogate and to assess the patients presenting with acute coronary syndrome, for the presence of conventional risk factors with special eye on diabetes and to stratify patients with acute coronary syndrome according to their diabetic status (Diabetic vs. non diabetic) and also to study pattern of involvement of coronary arteries in diabetic and non-diabetic patients and to stratify patient according to treatment they received PTCA vs. CABG.

Results: It was observed that out of 100 patients with diabetes mellitus, 71% patients were having diabetes mellitus. Among the diabetics in this study, STEMI (73.13%) was the commonest presentation of ACS. On the other hand amongst diabetics, 58.33% had STEMI.

Conclusion: Patients with diabetes mellitus had more dyslipidemia, hypertension and smokers. This group of patients required maximum intervention in the form PTCA and CABG.



Acute coronary syndrome, Diabetes mellitus, PTCA, CABG, STEMI

Full Text:



Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, et al. Acute coronary syndrome. In: Longo DL, Fauci AS, Kasper DL, Hauser SL, Jameson JL, Loscalzo J, et al., eds. Harrison’s Principles of Internal Medicine. 18th ed. New York: McGraw Hill Education; 2012: 2015.

Xavier D. Treatment and outcomes of acute coronary syndromes in India (CREATE): a prospective analysis of registry data. Lancet. 2008;371:1435-42.

Timoteo AT, Papoila AL, Rio P, Miranda F, Ferreira ML, Ferreira RC. Prognostic impact of admission blood glucose for all-cause mortality in patients with acute coronary syndrome: added value on top of GRACE risk score. Eur Heart J Acute Cardiovasc Care. 2014 Sep;3(3):257-63.

Lu HT, Nordin RB. Ethnic differences in the occurrence of acute coronary syndrome: results of the Malaysian national cardiovascular disease (NCVD) database registry (March 2006 - February 2010). BMC Cardiovasc Disord. 2013;6(13):97.

Gupta R. Lifestyle risk factors and coronary heart disease prevalence in Indian men. J Assoc Physicians India. 1996 Oct;44(10):689-93.

Singh RB, Sharma JP, Rastogi V, Raghuvanshi RS, Moshiri M, Verma SP, et al. Prevalence of coronary artery disease and coronary risk factors in rural and urban populations of north India. Eur Heart J. 1997;18(11):1728-35.

Diercks DB, Roe MT, Mulgund J, Pollack CV Jr, Kirk JD, Gibler WB, et al. The obesity paradox in non-ST-segment elevation acute coronary syndromes: results from the can rapid risk stratification of unstable angina patients suppress adverse outcomes with early implementation of the American College of Cardiology/American Heart Association Guidelines Quality Improvement Initiative. Am Heart J. 2006;152(1):140-8.

Arazzoni R, Aleksova A, Carriere C, Cattin MR, Zanetti M, Vinci P, et al. Obesity and high waist circumference are associated with low circulating pentraxin-3 in acute coronary syndrome. Cardiovasc Diabetol. 2013 Nov;12(1):167.

Selim S, Rahman R, Yasmin R, Karim N, Chowdhury SH, Lona H, et al. Risk factors of acute coronary syndrome among Bangladeshi people. Mymensingh Med J. 2013 Jul;22(3):513-21.

Mahmood M, Ashraf T, Memon MA, Achakzai J. Abdominal obesity pattern among various ethnic groups presenting with acute coronary syndrome. J Ayub Med Coll Abbottabad. 2010;22(3):132-5.

Milionis HJ, Kalantzi KJ, Papathanasiou AJ, Kosovitsas AA, Doumas MT, Goudevenos JA. Metabolic syndrome and risk of acute coronary syndromes in patients younger than 45 years of age. Coron Artery Dis. 2007;18(4):247-52.

Misiriya KJ, Sudhayakumar N, Khadar SA, George R, Jayaprakasht VL, Pappachan JM. The clinical spectrum of acute coronary syndromes: experience from a major center in Kerala. J Assoc Physicians India. 2009;57:377-83.

Shmulewitz D, Auerbach SB, Lehner T, Blundell ML, Winick JD, Youngman LD, et al. Epidemiology and factor analysis of obesity, type II diabetes, hypertension, and dyslipidemia (syndrome X) on the Island of Kosrae, Federated States of Micronesia. Hum Hered. 2001;51:8-19.

Panduranga P, Sulaiman KJ, Al-Zakwani IS, Lawati JA. Characteristics, management, and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman. Saudi Med J. 2010;31(5):520-4.

Pathy MS. Clinical Presentation of Myocardial Infarction in the elderly. Brit Heart J. 1967;29(190):190.

Muhammad AM, Shahzad AK, Sohail S, Ijaz-Ul-Haque T. Chest pain as a presenting complaint in patients with acute myocardial infarction (AMI). Pak J Med Sci. 2013;29(2):565-8.

Jedrzkiewicz S, Goodman SG, Yan RT, Grondin FR, Gallo R, Welsh RC, et al. Evaluation of left ventricular ejection fraction in non-ST-segment elevation acute coronary syndromes and its relationship to treatment. Am Heart J. 2010;159(4):605-11.

Altmann DR, Mutschelknauss M, Ehl N, Koller M, Schaer B, Jorg L, et al. Prevalence of severely impaired left ventricular ejection fraction after reperfused ST-elevation myocardial infarction. Swiss Med Wkly. 2013 Sep;143:w13869.

Gui MH, Qin GY, Ning G, Hong J, Li XY, Lu AK, et al. The comparison of coronary angiographic profiles between diabetic and non-diabetic patients with coronary artery disease in a Chinese population. Diabetes Res Clin Pract. 2009;85(2):213-9.

Natali A, Vichi S, Landi P, Severi S, L’Abbate A, Ferrannini E. Coronary atherosclerosis in type II diabetes: angiographic findings and clinical outcome. Diabetologia. 2000;43(5):632-41.

Greenhalgh J, Hockenhull J, Rao N, Dundar Y, Dickson RC, Bagust A. Drug-eluting stents versus bare metal stents for angina or acute coronary syndromes. Cochrane Database Syst Rev. 2010;(5):CD004587.

Novo G, Scordato F, Cerruto G, Vitale G, Ciaramitaro G, Coppola G et al. In-hospital stay of patient with acute coronary syndrome with or without diabetes mellitus. Minerva Cardioangiol. 2009;57(2):159-64.