Characteristics, management, and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman

ABSTRACT

To determine clinical characteristics, management, and in-hospital outcomes of diabetic and non-diabetic patients admitted with acute coronary syndrome [ACS] in Oman. Data were analyzed from 1583 consecutive patients admitted to various hospitals in Oman with ACS from May 8 to June 6, 2006, and from January 29 to June 29, 2007, as part of the Gulf RACE [Registry of Acute Coronary Events]. The ACS patients were stratified into those with and without diabetes mellitus. In this study, 588 [37%] patients were diabetic with a mean age of 59 years and included more female than male diabetics [43% versus 33%; p<0.001]. Diabetic patients were more likely to present with unstable angina [55% versus 44%; p<0.001] and less likely to present with ST elevation myocardial infarction [20% versus 27%; p=0.001]. Both groups received ACS treatment equally; however, diabetic patients were more likely to be treated with glycoprotein IIb/IIIa antagonists and angiotensin-converting enzyme inhibitors or receptor blockers. Diabetic patients experienced more recurrent ischemia [12% versus 8%; p=0.043], heart failure [29% versus 23%; p=0.009], cardiogenic shock [7.5% versus 4.6%; p=0.018], and ventilator requirement [7.3% versus 4.1%; p=0.006]. When adjusted for age and gender, diabetes status was an independent risk factor of in-hospital mortality in ACS patients [adjusted odd ratio, 1.68; 95% confidence interval, 1.02-2.77; p=0.042]. Diabetic ACS patients have different clinical characteristics and poorer outcomes. Present treatment strategies are not sufficient to counter the adverse impact of diabetes. More effective and evidence-based therapeutic strategies should be identified and used in diabetic ACS patients