Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease.
OBJECTIVE
Patients with diabetes and acute chest pain may be admitted to hospitals more frequently than patients without diabetes because physicians suspect atypical presentations for ischemic heart disease. This study aimed to determine whether the presentation of acute myocardial infarction and risk for major cardiac complications differs among patients without known coronary artery disease who do or do not have diabetes.


METHODS
Data from an emergency department of an urban teaching hospital on the medical histories, physical examinations, and electrocardiograms of 2,694 subjects with acute chest pain and without known coronary artery disease were prospectively recorded.


RESULTS
Diabetes was present in 301 (11%) patients. Compared with patients without diabetes, patients with diabetes were more likely to be < or = 60 years old (51% versus 20%) and to have a history of hypertension (70% versus 35%) or high blood cholesterol (35% versus 19%). A discharge diagnosis of acute myocardial infarction was made in 25 diabetic (8%) and in 148 nondiabetic (6%; P = 0.16) patients. A major cardiac complication occurred in two patients with diabetes (0.7%) and in 20 patients without diabetes (0.8%; P = 1.0). Patients with and without diabetes who had atypical chest pain complaints had similar rates of myocardial infarction (3% and 4%, respectively; P = 0.6). Patients with diabetes were more likely to be hospitalized (67% versus 47%; P = 0.001) both before and after adjusting for clinical and electrocardiographic data.


CONCLUSIONS
For patients with acute chest pain without a prior history of coronary artery disease, diabetes was not associated with a higher rate of acute myocardial infarction or complications. However, diabetes was associated with a higher rate of hospitalization in this population, suggesting that physicians have a lower threshold for admission to the hospital of patients with diabetes.
Lopez-Jimenez
F
F
Section for Clinical Epidemiology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02119, USA.
Goldman
L
L
Johnson
P A
PA
Polanczyk
C A
CA
Cook
E F
EF
Fleischmann
K E
KE
Orav
E J
EJ
Lee
T H
TH
D000208:Acute Disease; D000328:Adult; D000787:Angina Pectoris / Q000150:complications / Q000209:etiology*; D002637:Chest Pain / Q000150:complications / Q000209:etiology*; D003327:Coronary Disease / Q000150:complications / Q000175:diagnosis*; D048909:Diabetes Complications; D005260:Female; D006784:Hospitals, Teaching; D006786:Hospitals, Urban; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010343:Patient Admission; D011446:Prospective Studies; D014218:Triage