Abstract 11576: Demand Ischemia in Patients with Diabetic Ketoacidosis : A Retrospective Analysis

Abstract

Introduction: Demand ischemia (DI) or type 2 myocardial infarction refers to a mismatch between supply and demand of oxygen to myocardium leading to ischemia. Volume depletion is a cardinal feature of Diabetic Ketoacidosis (DKA) that can lead to decrease flow to myocardium. The purpose of this study is to document the incidence of demand ischemia in patients admitted with DKA. Methods: Using the Nationwide Inpatient Sample (NIS) for 2018, we performed a retrospective analysis of adults older than 18 years who were admitted to the hospital with a diagnosis of DKA. They were further divided in 2 groups. One group developed demand ischemia and the other group did not. Patients who suffered acute myocardial infarction were excluded from the study. Results: We had a total population of 202,505 that were admitted with the diagnosis of DKA, out of which 1685 (0.83%) patients suffered from demand ischemia. Comorbidities like prior diagnosis of DM, dyslipidemia, obesity, CKD, atrial fibrillation, chronic lung and liver disease were more prevalent in patients within the DI group (table 1). Complications like Acute kidney Injury (77.45% vs 39.77% p0.0001), Acute Respiratory Failure (15.43% vs 2.86% <0.0001), Ventricular arrhythmias (2.37% vs 0.43%) and Sudden cardiac arrest (1.48% vs 0.25% p<0.0001) occurred more frequently in DI subpopulation. Patients with DI underwent more procedures like angiography (12.46% vs 0.47% p<0.0001) and angioplasty (0.89% vs 0.08% p<0.0001). Overall, patients with DI had higher inpatient mortality (1.78% vs 0.42% p<0.0001) and longer length of stay (table 1). Conclusions: With wider availability of high sensitivity Troponin early recognition of myocardial ischemia has become possible. Demand Ischemia in DKA patients carried a higher burden of comorbidities, had more complications, underwent a higher number of procedures and had significantly higher number of deaths. Closer monitoring and precise management are prudent to avoid poor outcomes.