title: Acute coronary syndromes amongst type 2 diabetics with ischaemic electrocardiograms presenting to accident and emergency department of a Kenyan tertiary institution.
abstract: OBJECTIVE
  To determine the prevalence of acute coronary syndromes among type 2 diabetic patients presenting to Accident and Emergency department.
  
  
  METHODS
  Prospective cross-sectional study.
  
  
  METHODS
  Kenyatta National Hospital, a tertiary teaching and referral hospital.
  
  
  METHODS
  Type 2 diabetic patients with ischaemic electrocardiograms (ECG).
  
  
  METHODS
  Demographics, clinical symptoms, cardiovascular status and risk factors--central obesity, hypertension, dyslipidaemia, smoking.
  
  
  RESULTS
  From 12,307 accident and emergency attendees, 400 (33%) diabetics aged > OR =30 years were screened with a resting ECG and 95 (24%) with ischaemic ECG were recruited; age range 41-87 years, 60% were male; diabetes duration ranged 0-30 years with 8.4% being newly diagnosed. The commonest enrolling ECG feature was nonspecific ST-T changes. The commonest presenting complaint were fatigue and dyspnoea. Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevated LDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulin and OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) were classified as acute coronary syndrome (ACS); 29 (30.5%) acute myocardial infarction (ACS-AMI) and five (5.2%) unstable angina (ACS-UA). Majority (79.4%) of the ACS presented more than six hours after symptom onset and majority had features of acute left ventricular failure.
  
  
  CONCLUSIONS
  Acute coronary syndrome accounted for 35% of the morbidity in type 2 diabetics with ischaemic ECG's presenting to KNH accident and emergency department; patients presented late and 80% were not on CAD prophylactic therapy.
authors.affiliation: Department of Clinical Medicine and Therapeutics, School of Medicine, College of Health Sciences, University of Nairobi, P.O. Box 19676-0202, Nairobi, Kenya.
authors.forename: H K
authors.initials: HK
authors.lastname: Nguchu
authors.forename: M D
authors.initials: MD
authors.lastname: Joshi
authors.forename: C F
authors.initials: CF
authors.lastname: Otieno
mesh_terms: D054058:Acute Coronary Syndrome / Q000175:diagnosis* / Q000453:epidemiology*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004562:Electrocardiography; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D015995:Prevalence