Abstract 14544: Cardiovascular Outcomes Among Patients With Acute Coronary Syndromes and Diabetes in India: Results From ACS QUIK Trial

Abstract

Introduction: Patients with diabetes are more likely to experience an acute myocardial infarction (AMI), heart failure, or death from cardiovascular (CV) causes than patients without diabetes. Despite cardiovascular disease being the leading cause of death in India, limited data exists on the outcome of patients with diabetes who suffer acute cardiovascular events. Hypothesis: Diabetes is common in patients with acute myocardial infarction (AMI) in India and is associated with worse in-hospital and 30-day cardiovascular outcomes. Methods: We examined 21374 patients with AMI enrolled in the Acute Coronary Syndrome Quality Improvement in Kerala trial. We compared those with and without diabetes with regards to the development of in-hospital and 30-day major adverse cardiac events including death, re-infarction, stroke, or major bleeding. The associations between diabetes and cardiac outcomes were adjusted for presentation and in-hospital management using logistic regression. Results: mean±SD age was 60.1±12.0 years and 24.3% were females. A total of 44.4% of AMI patients had diabetes. Those with diabetes were more likely to be older, female, with hypertension and have higher Killip class on presentation but less likely to present with STEMI. Patients with diabetes had longer symptoms onset-to-arrival (median 225 vs 290 min; P<0.001) and, in case of STEMI, longer door-to-balloon times (median, 75.0 vs 91 min; P<0.001). Diabetes was independently associated with higher in-hospital death (adjusted odds ratio [aOR], 1.46; 95% CI, 1.12-1.89), in-hospital reinfarction (aOR 1.52; 95% CI, 1.15-2.02). Diabetes was also associated with higher 30-day MACE (aOR, 1.33; 95% CI, 1.14-1.55) and 30-day death (aOR, 1.40; 95%CI, 1.16-1.69) but not 30-day stroke or 30-day bleeding. Conclusion: Among patients presenting with AMI in Kerala, India, a considerable proportion has diabetes and are at increased risk for in-hospital and 30-day adverse cardiovascular outcomes. Increased awareness of the increased CV risk and attention to the implementation of established cardiovascular therapies are indicated for patients with diabetes in lower-middle income countries who develop AMI.