Epidemiological-clinical and paraclinical particularities of acute coronary syndrome without persistent ST-segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population.

Abstract

This study aimed at determining the epidemiological-clinical and paraclinical particularities of non-ST-segment elevation acute coronary syndrome (NSTE-ACS) in Malagasy with type 2 diabetes mellitus (T2DM). This was a retrospective, descriptive and comparative study between patients with and without T2DM, carried out over a period of 38 months. The diagnosis of NSTE-ACS was retained in front of the association of chest discomfort, electrical abnormalities and elevations beyond fivefold the upper reference limit of high-sensitivity cardiac troponin. With 130 patients included, the overall prevalence of NSTE-ACS was 4.1%, of which 68 patients (52.3%) had T2DM. Compared to without T2DM, NSTE-ACS in T2DM was characterized by young age (p= .0002), high-frequency hypertension (OR 2.92 [1.23-7.25]; p= .0041), overweight/obesity (OR 4.39 [1.72-12.4]; p= .0002) and microalbuminuria (p< .0001), accelerated heart rate (p= .0104), atypical chest discomfort (OR 5.57 [2.21-15.7]; p< .0001), pulmonary crepitations (OR 2.25 [1.02-5.14]; p= .0224), high GRACE score (p= .0016), damage of extensive anterior leads (OR 2.11 [1.02-4.98]; p= .0402) and septal lead (OR 3.64 [1.41-10.3]; p= .0015), significant increase in cardiac troponin (p< .0001), high left ventricular filling pressure (OR 3.39 [1.51-7.90]; p= .001). NSTE-ACS in T2DM is frequent, with an atypical clinical and severe paraclinical presentations. Adequate and multidisciplinary management of cardiovascular risk factors, including T2DM, could thus minimize the occurrence of NSTE-ACS and improve this profile.