Md Suhail Alam¹*, Muhammad Shahabuddin² and SM Habibullah³

¹MD (Cardiology) – Thesis Part, Department of Cardiology, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
²Professor & Head, Department of Cardiology, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh
³Associate Professor, Department of Cardiology, Sylhet MAG Osmani Medical College, Hospital, Bangladesh

*Corresponding Author: Md Suhail Alam, MD (Cardiology) – Thesis Part, Department of Cardiology, Sylhet MAG Osmani Medical College, Sylhet, Bangladesh.

Received: September 11, 2023; Published: September 29, 2022

Abstract

Background: Patients with acute anterior myocardial infarction and diabetes have a poor prognosis.

Objectives: To see the in-hospital outcome of acute anterior myocardial infarction in diabetic and non-diabetic patients.

Methodology: This cross-sectional observational study was conducted in the Department of Cardiology, Sylhet MAG Osmani Medical College Hospital, Sylhet over a period of two years from July 2015 to June 2017. A total of 100 acute anterior MI patients (50 diabetic and 50 non diabetic) were included in this study. Acute anterior MI patients admitted after 6 hours of symptom onset or who did not receive streptokinase were excluded.

Results: Male predominance was obvious in both groups [40 (80%) versus 42 (84%); p > 0.05] in diabetic and non-diabetic group respectively. Mean age was 53.34 ± 11.32 and 54.84 ± 14.12 years in diabetic and non-diabetic groups respectively. Dyslipidemia [6 (12%) versus 6 (12%); p >0.05], Smoking [32 (64%) versus 34 (68%); p >0.05] and Family history of cardiovascular disease [6 (12%) versus 4 (8%); p >0.05] were similar among diabetic and non-diabetic respectively. Hypertension was found more among non-diabetic [27 (54%) versus 19 (38%); p > 0.05] but difference was not statistically significant. Diabetic group had more Apical Anterior MI [22 (44%) versus 19 (38%); p < 0.05] and Extensive Anterior MI [20 (40%) versus 11 (22%); p < 0.05] while non-diabetic group had more Septal MI [10 (20%) versus 3 (6%); p < 0.05] and Mid Anterior MI [10 (20%) versus 4 (8%); p < 0.05]. LV ejection fraction was found significantly low in diabetic patients [43.96 ± 5.95 versus 53.68 ± 6.36; p < 0.01]. Killip Class III was more in diabetic [24 (48%) versus 9 (18%); p < 0.01] and Killip Class I was more in non-diabetic group [18 (36%) versus 3 (6%); p < 0.01] according to Killip classification of HF which was statistically significant between the two groups. Atrial Fibrillation was more in diabetics [6 (12%) versus 1 (2%); p < 0.05] while sinus tachycardia was more among non-diabetics [20 (40%) versus 5 (10%); p < 0.05] which are statistically significant. Diabetic group had more acute MR [2 (4%) versus 0 (0%); p > 0.05] but was not significant. Death was more in diabetic group than that of non-diabetic group [7 (14%) versus 3 (6%); p > 0.05] but it was statistically not significant.

Conclusion: It is concluded from the present study that in hospital outcomes of acute anterior myocardial infarction are worse in diabetic patients than in non-diabetic patients.

Keywords: Outcome; Acute Anterior Myocardial Infarction; Diabetic

References

1. O'Gara PT., et al. “ACCF/AHA guideline for the management of ST-elevation myocardial infarction: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines”. Circulation4 (2013): e362-425.
2. Goldberg RJ., et al. “A 25-year perspective into the changing landscape of patients hospitalized with acute myocardial infarction (the Worcester Heart Attack Study)”. The American Journal of Cardiology 11 (2004): 1373-1378.
3. Shabbir M., et al. “Predictors of fatal outcome in acute myocardial infarction”. Journal of Ayub Medical College Abbottabad 3 (2008): 14-16.
4. Iqbal MJ., et al. “Complications and Mortality in St-Segment Elevation Acute Myocardial Infarction in Diabetic and Non-Diabetic Patients”. Medical Journal of Islamic World Academy of Sciences2 (2011): 87-94.
5. International Diabetes Federation (IDF). Country estimates table 2011. IDF diabetes atlas. 6^th (2013).
6. Park KH., et al. “Different impact of diabetes mellitus on in-hospital and 1-year mortality in patients with acute myocardial infarction who underwent successful percutaneous coronary intervention: results from the Korean Acute Myocardial Infarction Registry”. The Korean Journal of Internal Medicine2 (2012): 180-188.
7. Hsu HP., et al. “Comparison of in-hospital outcome of acute ST elevation myocardial infarction in patients with versus without diabetes mellitus”. Acta Cardiologica Sinica3 (2011): 145-151.
8. Ahmed J., et al. “Acute myocardial infarction: A comparative study to assess the angiographic changes in diabetic and non diabetic patients”. Professional Medical Journal8 (2015).
9. Kosiborod M., et al. “Glucometrics in patients hospitalized with acute myocardial infarction”. Circulation8 (2008): 1018-1027.
10. Kosiborod M., et al. “Admission glucose and mortality in elderly patients hospitalized with acute myocardial infarction”. Circulation23 (2005): 3078-3086.
11. Hasin T., et al. “Comparison of treatment and outcome of acute coronary syndrome in patients with versus patients without diabetes mellitus”. The American Journal of Cardiology6 (2009): 772-778.
12. Thygesen K., et al. “Universal definition of myocardial infarction”. Journal of the American College of Cardiology22 (2007): 2173-2195.
13. American Diabetes Association. “Classification and Diagnosis of Diabetes”. Diabetes Care 39 (2016): S13-22.
14. Jacoby RM and Nesto RW. “Acute myocardial infarction in the diabetic patient: pathophysiology, clinical course and prognosis”. Journal of the American College of Cardiology3 (1992): 736-744.
15. Mozaffarian D., et al. “Heart disease and stroke statistics - 2015 Update”. Circulation 4 (2015): 434-441.
16. Mak K H., et al. “Influence of diabetes mellitus on clinical outcome in the thrombolytic era of acute myocardial infarction”. Journal of the American College of Cardiology1 (1997): 171-179.
17. Stone PH., et al. “The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis”. Journal of the American College of Cardiology1 (1989): 49-57.
18. Sricharan KN., et al. “Study of acute myocardial infarction in young adults: Risk factors, presentation and angiographic findings”. Journal of Clinical and Diagnostic Research2 (2012): 257-260.
19. Zuanetti G., et al. “Influence of diabetes on mortality in acute myocardial infarction: data from the GISSI-2 study”. Journal of the American College of Cardiology7 (1993): 1788-1794.
20. Partamian JO and Bradley RF. “Acute myocardial infarction in 258 cases of diabetes”. New England Journal of Medicine 9 (1965): 455-461.

Citation

Citation: Md Suhail Alam., et al. “In Hospital Outcome of Acute Anterior Myocardial Infarction in Diabetic and Non-Diabetic Patients". Acta Scientific Cardiovascular System 2.4 (2023): 18-25.

Copyright

Copyright: © 2023 Md Suhail Alam., et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.