Abstract
BackgroundThis study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department.MethodsWe analyzed the clinical data of all consecutive patients admitted to the emergency department during the years 2012 and 2013 with at least 1 cardiac Troponin I (cTnI Ultra Siemens, Advia Centaur) determination, and were classified according to the status of diabetes mellitus (DM) and myocardial injury (MI). Clinical events were evaluated in a 4-year follow-up.ResultsA total of 3622 patients were classified according to the presence of DM (n = 924 (25.55%)) and MI (n = 1049 (28.96%)). The proportion of MI in patients with DM was 40% and 25% in patients without DM. Mortality during follow-up was 10.9% in non-DM patients without MI, 21.3% in DM patients without MI, 40.1% in non-DM patients with MI, and 52.8% in DM patients with MI. A competitive risk model was used to obtain the Hazard Ratio (HR) for readmission for myocardial infarction or heart failure. There was a similar proportion of readmission for myocardial infarction and heart failure at a four-year follow-up in patients with DM or MI, which was much higher when DM was associated with MI, with respect to patients without DM or MI. The HR (95% Coefficient Interval) for myocardial infarction in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2511 (1592–3960), 2682 (1739–4138), and 5036 (3221–7876), respectively. The HR (95% CI) for the risk of readmission for heart failure in the DM without MI, non-DM with MI, and DM with MI groups with respect to the non-DM without MI group was 2663 (1825–3886), 2562 (1753–3744) and 4292 (2936–6274), respectively.ConclusionsThe association of DM and MI in patients treated in an Emergency Service identifies patients at very high risk of mortality and cardiovascular events.
Highlights
Diabetes mellitus (DM) is an important cardiovascular risk factor, and it is frequent among patients attending the emergency department with suspected acute coronary syndrome [1]
Patients were identified using laboratory records. Cardiac Troponin I (cTnI) tests were performed according to the chest pain protocol of our center, these biochemical analyses were requested in patients with atypical symptoms or suspected acute coronary syndrome (ACS)
Baseline characteristics The total population included in the study was 3622 patients, who were classified according to the presence of DM (n = 924 (25.55%)) and myocardial injury (MI) (n = 1049 (28.96%))
Summary
Diabetes mellitus (DM) is an important cardiovascular risk factor, and it is frequent among patients attending the emergency department with suspected acute coronary syndrome [1]. DM affects the prognosis of these patients, regardless of ruling out an acute coronary syndrome [2]. In patients with symptoms compatible with an acute coronary syndrome, cardiac troponin (cTn) determination can confirm or rule out myocardial infarction. Type 1 myocardial infarction (T1MI), or spontaneous myocardial infarction related to ischaemia, is due to a primary coronary event such as plaque erosion and/or rupture, fissuring, or dissection. Type 2 myocardial infarction (T2MI), or secondary to ischaemia, is due to either increased oxygen demand or decreased supply [3]. This study aimed to investigate the clinical features and prognosis of diabetes and myocardial injury in patients admitted to the emergency department
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