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. 2019 May;16(5):395-400.
doi: 10.11909/j.issn.1671-5411.2019.05.002.

Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction-an analysis from China Acute Myocardial Infarction (CAMI) registry

Rui Fu  1 , Si-Dong Li  1 , Chen-Xi Song  1 , Jing-Ang Yang  1 , Hai-Yan Xu  1 , Xiao-Jin Gao  1 , Yi Xu  1 , Jian-Ping Zeng  2 , Jun-Nong Li  3 , Ke-Fei Dou  1 , Yue-Jin Yang  1
Affiliations

Clinical significance of diabetes on symptom and patient delay among patients with acute myocardial infarction-an analysis from China Acute Myocardial Infarction (CAMI) registry

Rui Fu et al. J Geriatr Cardiol. 2019 May.

Abstract

Background: Diabetes is frequently associated with poor prognosis among acute myocardial infarction (AMI) patients. Patients with these comorbidities often have atypical symptoms and subsequent delay in treatment. Few studies have reported detailed AMI symptoms in patients with diabetes. This study compared AMI symptoms and presentation characteristics between diabetics and non-diabetics.

Methods: We included patients from the China AMI registry diagnosed with AMI between January 2013 and September 2014. Baseline characteristics, symptomology, and delay in treatment were compared between diabetics and non-diabetics. Multivariable logistic regression analysis was used to explore independent predictors of atypical symptoms.

Results: A total of 4450 (20.2%) patients had diabetes. They were older, more often women, higher in body mass index, and more likely to have non-ST segment elevation myocardial infarction. Fewer diabetic patients presented with persistent precordial chest pain (63.1% vs. 68%, P < 0.0001), diaphoresis (60.1% vs. 65.6%, P < 0.0001), fatigue (16.7% vs. 18.3%, P = 0.0123), and incontinence (0.4% vs. 0.7%, P = 0.0093). Time to hospital presentation was longer among patients with diabetes than those without. In multivariable analysis, diabetes was identified as an independent predictor of atypical symptoms (OR: 1.112, 95% CI: 1.034-1.196).

Conclusions: Our study is the first large-scale study providing evidence that diabetics are less likely to present with typical chest pain and more likely to experience treatment delay when suffering from an AMI. Our results may increase clinician awareness of recognizing AMI patients rapidly to reduce diagnosis and treatment delay, particularly in the context of diabetes.

Keywords: Acute myocardial infarction; Diabetes; Patient delay; Symptoms.

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Figures

Figure 1.
Figure 1.. Study flow chart.
From January 2013 to September 2014, a total number of 26,082 AMI patients were registered in CAMI registry. We excluded 4088 patients due to missing or invalid data on age, BMI, on admission diagnosis and symptomology and finally included 21,994 patients. Among these patients, 4450 patients had diabetes and 17544 patients were non-diabetes. CAMI: China acute myocardial infarction.
See this image and copyright information in PMC

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