« Previous Article
Next Article »

Original Research (Original Article) 


Walaa A. Aldarwish et al, 2020;4(3):620–628.

International Journal of Medicine in Developing Countries

Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia

Walaa A. Aldarwish1*, Ali A. Alqarni2, Abdulrahman A. Medawi1, Afnan Z. Alhwaishel1, Amani H. AbuHassan1, Baqer Aldarwish1

Correspondence to: Walaa A. Aldarwish

*College of Medicine, King Khalid University, Abha, Saudi Arabia.

Email: walaa.abdulaziz94 [at] gmail.com

Full list of author information is available at the end of the article.

Received: 23 November 2019 | Accepted: 16 January 2020


ABSTRACT

Background:

Diabetes mellitus is linked strongly with the development of coronary artery disease, and therefore, early prevention is more required among diabetics. The diabetic patient needs special care and observation with a view to the prevention, control, and treatment of the various manifestations of coronary artery disease. This study aims to assess the differences in myocardial infarction (MI) risk factor distribution and inhospital outcome among diabetic and nondiabetic patients.


Methodology:

A prospective observational study was conducted on a selected sample of patients with MI who are admitted in the Cardiac Department at Aseer Central Hospital from 1st June to 30th December 2017. Data were collected from the medical record, and the patients were followed up to find the outcomes and complications.


Results:

Among a total of 306 subjects included (203 diabetics and 103 nondiabetics), with the ages of 20–85 years, males were 76.1% and females were 23.9%. Among the diabetic groups, 49.3% were diagnosed as ST-segment elevated MI. Non ST-segment elevated MI was diagnosed in 21.7% of diabetics, whereas the rest 29.1% had unstable angina. The obesity was recorded among 84.2% of diabetics compared to 75.7% of nondiabetics (p = 0.014). Hypertension was recorded among 77.8% of diabetics compared to 42.7% of nondiabetics (p = 0.001). The MI complications, atrial fibrillation, and arrhythmia were higher among diabetic groups (22.2% vs. 26.6%) compared to nondiabetics (3.9% vs. 5.8%). The death rate was higher among diabetic patients with coronary artery disease than among nondiabetics (6.4% vs. 1%).


Conclusion:

Diabetic patients with MI had a greater prevalence of cardiometabolic risk factors (obesity, abdominal obesity, and hypertension) as compared to nondiabetic patients. The inhospital outcome was worse among diabetic patients.


Keywords:

MI, DM, acute coronary syndrome (ACS), risk factors, cardiac outcome, Saudi Arabia.


Introduction

Cardiovascular complications are more common among diabetic patients and are usually associated with a significantly greater risk of morbidity and mortality than in nondiabetic subjects [1]. Diabetes worsens prognosis in myocardial infarction (MI). The risk of developing MI is 50% greater in diabetic males and by 150% greater in diabetic females compared to age-matched nondiabetic subjects [2]. Diabetes affects mainly the fate following coronary artery disease, and therefore, early prevention is more required among diabetics. Consequently, the diabetic patient needs special care and observation, with a view to the prevention, control, and treatment of the various manifestations of coronary artery disease [3,4]. In the Latin-American population, patients with known diabetes mellitus 2 (DM2) had a greater risk of prolonged hospital stay and inhospital heart failure compared to the normal glycemic group [5]. In 1995, 2,153 individuals with MI were recruited from 20 adjacent hospitals within Yorkshire, UK. About 13% had known DM. They experienced higher mortality at 30 days and 20 years [6]. From the Multicenter Investigation of Limitation of Infarct Size study, the course of acute infarction in 85 diabetic patients has compared with 415 nondiabetic patients; the diabetic patients experienced a more complicated inhospital and postdischarge course than did the nondiabetic patients [7]. The observational study from the National Cardiovascular Data Registry from January 2007 to March 2011 entered into the registry. There was an increased adjusted risk of inhospital mortality in the DM group in both ST-elevated myocardial infarction (STEMI; odds ratio [OR] 1.14, 95% confidence interval [CI] 1.06–1.22) and STEMI (OR 1.17, 95% CI 1.07–1.27) population [8]. Forty patients with unstable angina and non ST-elevated myocardial infarction (NSTEMI) were examined consecutively during 2013–2015 years. Patients with unstable angina and NSTEMI in associations with DM2 are characterized by an increased heart rate partly resistant to β-blockers, which indicates the worse prognosis of cardiovascular diseases [9]. The result of a cohort study at all 11 central MA medical centers between 1999 and 2009, diabetic patients presenting with NSTEMI, remains at high risk of developing significant clinical complications during hospitalization [10]. The diabetic patients have a higher risk of cardiovascular diseases such as MI that indicates there is a relationship between DM and MI. In Saudi Arabia, local epidemiological data about complications and risk factors among MI patients with DM are scarce. Control blood sugar in the diabetic patient with MI delays or decreases the other complication of it. Hence, it is important to conduct such a study to know how DM affects the outcome and risk factors of MI compared to nondiabetics.


Subjects and Methods

A longitudinal prospective observational study was conducted on patients with MI (diabetics and nondiabetics) who were admitted to the Cardiac Department in Aseer Central Hospital (ACH), Abha, Saudi Arabia, during the period from 1st June to 30th December 2017. A total of 306 patients (203 diabetics and 103 nondiabetics) were included during the study period whose medical records were reviewed to identify the target cases with MI, main data, diabetic status, clinical presentations, treatment received, investigations, and procedures done and its results; then, the patients were followed up until discharge or death to identify the outcome and complications. Data collected included patient’s age, sex, weight and height, medical history (risk factors and complications), laboratory test results, and length of hospital stay. The collected data were then revised, coded, and fed to the statistical software Statistical Package for the Social Sciences (SPSS), IBM version 21. The given graphs were constructed using Microsoft Excel software. All statistical analyses were performed using two-tailed tests and an alpha error of 0.05. A p-value less than or equal to 0.05 was considered to be statistically significant. The descriptive statistics including frequencies and percentages were used to describe the frequency of each response for categorical data. Chi-square test/Monte Carlo exact test and Fisher’s exact test (if there were many small expected values) were used to test the association between diabetic status and distribution of different studied risk factors and outcomes.

Figure 1. Distribution of patients admitted to the cardiac department in ACH, Abha, Saudi Arabia, according to their diabetic status.


Results

The study included 306 subjects with MI, 203 diabetic patients 66.3% and 103 nondiabetics 33.7% (Figure 1). Ages for the two groups ranged from 21 to 85 years old with a mean age of 62 ± 10.8 and 54 ± 16.7 for diabetics and nondiabetics, respectively. Male gender was recorded among 155 of the diabetic patients and 78 of nondiabetics. Concerning the clinical presentation of MI (Table 1), shortness of breath (SOB) was significantly higher among diabetic patients (83.3%) compared to 66% of nondiabetics (p < 0.05). Furthermore, high jugular venous pressure (JVP) was significantly higher among diabetics (17.2%) compared to nondiabetic patients (8.7%). Other clinical presentations including angina, orthopnea, palpitation, and lung crepitation were insignificantly different among diabetic and nondiabetic groups.

Table 1. Clinical presentations among diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

Clinical presentation Group Total p
Nondiabetics Diabetics
No % No % No %
Typical angina 81 78.6% 159 78.3% 240 78.4% 0.949
Atypical angina 17 16.5% 38 18.7% 55 18.0% 0.634
SOB 68 66.0% 169 83.3% 237 77.5% 0.001*
Orthopnea 20 19.4% 49 24.1% 69 22.5% 0.350
PND 20 19.4% 46 22.7% 66 21.6% 0.515
Palpitation 32 31.1% 86 42.4% 118 38.6% 0.055
High JVP 9 8.7% 35 17.2% 44 14.4% 0.045*
Lung crepitation 4 3.9% 13 6.4% 17 5.6% 0.363
S4 1 1.0% 0 0.0% 1 0.3% 0.160
S3 9 8.7% 24 11.8% 33 10.8% 0.411

*p < 0.05 (significant)

SOB: shortness of breath

PND: paroxysmal nocturnal dyspnea

JVP: jugular venous pressure

Table 2. ACS data among diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

ACS Group Total p
Nondiabetics Diabetics
No. % No. % No. %
Type of ACS STEMI 64 62.1% 100 49.3% 164 53.6% 0.040*
NSTEMI 22 21.4% 44 21.7% 66 21.6%
Unstable angina 17 16.5% 59 29.1% 76 24.8%
ECG findings Nonspecific change 15 39.5% 25 25.8% 40 29.6% 0.011*
ST depression 4 10.5% 15 15.5% 19 14.1%
T-wave inversion 13 34.2% 14 14.4% 27 20.0%

STEMI: ST-elevated myocardial infarction

NSTEMI: Non ST-elevated myocardial infarction

The MI was recorded between the two groups, but the most dominant among diabetic patients was STEMI (49.3%) compared to nondiabetic patients (62.1%), followed by NSTEMI (21.7%) compared to nondiabetic group (21.4%) with borderline statistical significance (p = 0.090). Concerning electrocardiogram (ECG) findings, nonspecific changes were found among 25.8% of the diabetic groups compared to 39.5% of the nondiabetics. Ischemic changes in the form of ST depression was recorded among 15.5% of the diabetic groups compared to 10.5% of the nondiabetics, whereas T-wave inversion was recorded among 14.4% of the diabetics compared to 34.2% of the nondiabetics with recorded statistical significance (p < 0.05) (Table 2). Table 3 describes the distribution of the different MI risk factors between the two groups. Age was significantly different as 62.1% of the diabetics aged 65 years or more compared to 34% of the nondiabetics (p < 0.05). Body mass index (BMI) was also significantly different between the two groups as 84.2% of the diabetics weighed above normal compared to 75.7% of the nondiabetics (p < 0.05). About 21% of the diabetics were smokers compared to 50% of the nondiabetics with recorded statistical significance. About 78% of the diabetic patients with MI were hypertensive, which is significantly higher than the portion recorded among nondiabetics (42.7%). Hyperlipidemia was found among 29.1% of diabetic patients compared to 13.6% of the nondiabetics (p < 0.05). All other studied risk factors including gender, job nature, renal disorders, and others had nearly the same distribution between the two groups. Concerning MI complications, atrial fibrillation was recorded among 22.2% of diabetic patients compared to 3.9% of the nondiabetics. Furthermore, 26.6% of the diabetic groups had arrhythmia compared to 5.8% of the nondiabetic patients with recorded statistical significance for both. Cardiac pulmonary edema, stroke, and cardiogenic shock were recorded equally between the two groups (Figure 2). Figure 3 shows the distribution of lipid profiles between the two groups, and it was clear that there was no significant difference regarding cholesterol, triglyceride, high density lipoprotein, and low density lipoprotein (LDL) between the two groups. On performing cardiac catheter, 53% of the diabetic patients with MI had triple vessel disease compared to 45.9% of the nondiabetics, whereas mild coronary artery disease (mild CAD) was recorded among 9.8% of the diabetics compared to 12.9% of the nondiabetic patients. Ejection fraction ranged from 15% to 70% among the diabetic patients with a mean level of 45.4% ± 11.6%, whereas among the nondiabetics, it ranged from 20% to 71% with a mean value of 48.6% ± 11.2% with recorded statistical significance (Table 4).

Table 3. CVDs risk factors distribution among diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

Risk factors DM Total p
Nondiabetics Diabetics
No. % No. % No. %
Gender Male 78 75.7% 155 76.4% 233 76.1% 0.903
Female 25 24.3% 48 23.6% 73 23.9%
Age (years) 20– 22 21.4% 2 1.0% 24 7.8% 0.001*
40– 46 44.7% 75 36.9% 121 39.5%
60+ 35 34.0% 126 62.1% 161 52.6%
BMI Normal weight 25 24.3% 32 15.8% 57 18.6% 0.043*
Overweight/Obese 78 75.7% 171 84.2% 249 81.4%
Smoking No 51 49.5% 161 79.3% 212 69.3% 0.001*
Yes 52 50.5% 42 20.7% 94 30.7%
Hypertension No 59 57.3% 45 22.2% 104 34.0% 0.001*
Yes 44 42.7% 158 77.8% 202 66.0%
Renal disease No 95 92.2% 192 94.6% 287 93.8% 0.421
Yes 8 7.8% 11 5.4% 19 6.2%
Hyperlipidemia No 89 86.4% 144 70.9% 233 76.1% 0.003*
Yes 14 13.6% 59 29.1% 73 23.9%

BMI: body mass index

Figure 2. CVDs complications among diabetic and nondiabetic patients admitted to a cardiac department in ACH, Abha, Saudi Arabia.

Figure 3. Lipid profile among diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

Table 4. Catheterization and echocardiogram findings among diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

Cauterization findings Group Total p
Nondiabetics Diabetics
No % No % No %
Cardiac catheterization Single vessel disease 13 15.3% 25 15.2% 38 15.3% 0.724
Two vessel disease 18 21.2% 32 19.5% 50 20.1%
Triple vessel disease 39 45.9% 87 53.0% 126 50.6%
Normal 4 4.7% 4 2.4% 8 3.2%
Mild CAD 11 12.9% 16 9.8% 27 10.8%
Range 20%–71% 15%–70% 15%–71% 0.023*#
Ejection fraction Mean ± SD 48.6% ± 11.2% 45.4% ± 11.6% 46.4% ± 11.5%
Median 50% 45% 46%

Mild CAD: mild coronary artery disease

Finally, on studying the outcome of MI between the two groups (Table 5), it was clear that death was recorded among 6.4% of the diabetic patients compared to only one case of the nondiabetics. About 88% of the diabetics were discharged stable compared to 98.1% of the nondiabetics with recorded statistical significance (p = 0.05). On follow-up, 57.7% of the diabetic patients were symptomatic compared to 38.3% of the nondiabetics. The main symptom recorded among the diabetic patients was chest pain (40.6%) followed by SOB (39.1%), and among the nondiabetics, the main symptom was chest pain (78.9%).


Discussion

The study was conducted to assess the differences in MI risk factor distribution and outcome among the diabetic and nondiabetic patients in the Saudi population using prospective observational study among patients who were admitted to the Cardiac Department in ACH. The data were collected based on history, clinical examination, laboratory findings, and medical records; then, the patients were followed up to identify outcomes and complications. DM is a major public health problem worldwide, and it is a known risk factor for CAD. In this study, we found that 66.3% of the patients who admitted to the cardiac department were diabetic, whereas nondiabetic patients constitute 33.7%, and this is similar to a study done by Al-Nozha et al. [11] in Saudi Arabia between 1995 and 2000 which reported that the overall prevalence of DM in Kingdom of Saudi Arabia (KSA) is 23.7% among adults. Based on a study done by Aljefree and Ahmed [12] between 1990 and 2014 in Gulf Region, it was reported that the prevalence of DM among patients with cardiovascular disease was ranged from 9.3% to 46.8%. In this study, we have found that the MI risk factor distribution was more common in diabetic patients and the outcome worsen among diabetic patients compared to nondiabetics. This is similar to a study done by Al Slail et al. [13] between 2008 and 2012 which reported that among Saudi Arabian citizens with diabetes, 70% had two or more cardiovascular disease (CVD) risk factors in addition to diabetes. This finding is also consistent with other study done by Gomez-Arbelaez et al. [2] in Latin-America, reported hyperglycemia increases the risk of prolonged hospital stay in patients with MI compared to non-diabetic patients p = 0.003. Table 1 describes the clinical presentations among diabetic and nondiabetic patients admitted to the cardiac department in ACH. In our study, we found that 78.3% of diabetic patients had typical angina, whereas 18.7% had atypical angina, compared to 78.6% of nondiabetic patients who had typical angina, whereas 16.5% had atypical symptoms; this finding is insignificant. Hence, there is no difference between diabetic and nondiabetic patients for kinds of chest pain which is comparable to Ahmed et al. [14] study conducted in Pakistan from 1st November 2015 to 30th April 2016, who reported that chest pain was the most common symptom in both diabetics (n = 101, 77%) and nondiabetics (n = 130, 87%). In this study, we found that some patients present with symptoms of heart failure such as SOB, orthopnea, paroxysmal nocturnal dyspnea (PND), palpitation, high JVP, lung crepitation, S3, and S4, and this is consistent with Albackr et al. [15] study in KSA from 2005 to 2007, who reported that a total of 4,523 patients with acute coronary syndrome (ACS) were identified, of whom 905 (20%) had congestive heart failure. The SOB is higher in diabetic patients (83.3%) compared to nondiabetics (66%) with a significant difference of p = 0.001, and this is consistent with a study done by Islam et al. [16] from December 2011 to June 2012, which reported that the dyspnea was higher in diabetic patients with ACS compared to nondiabetics (53.3% vs. 36.7%, p = 0.0315). Table 2 shows ACS data among diabetic and nondiabetic patients admitted to the cardiac department in ACH. In this study, the most common type of ACS is STEMI (53.6%), followed by unstable angina (UA) (24.8%) and NSTEMI (21.6%, p = 0.040), and this is similar to Al-Murayeh et al. [17] study in Aseer region between January 2006 and May 2009, which reported that among ACS patients, 38.3% had STEMI, 33.6% NSTEMI, and 28.0% UA. According to ECG finding among patients with NSTEMI and unstable angina, ischemic changes in the form of ST depression were recorded among 30% of the patients, whereas T-wave inversion was 48.6%, and this is consistent with Birnbaum et al. [18] study, who concluded that in many patients, the ECG changes include ST-segment deviation and change T-wave morphology were minimal or reflect a reperfusion stat. During active ischemia, the ECG changes include ST-segment deviation and T-wave morphology. Table 3 shows the CVD risk factor distribution among diabetic and nondiabetic patients admitted to the cardiac department in ACH. The MI in elderly male patients aged 65 years or more among diabetic patients (62.1%) compared to 34% of nondiabetic patients (p = 0.001), and this is compatible with Ahmed et al. [19] study at KSA between July 2011 and April 2012, which reported that a total of 550 participants were enrolled from different clinics across Saudi Arabia [aged (mean ± standard deviation) 43 ± 11 years; 71% of males]. In a cross-sectional study conducted by Alharthi et al. [20] in May 2016 at KSA to assess the prevalence of CVD risk factors, it was reported that a total of 507 participants were included (76.3% of males and 23.7% of females). In this study based on BMI among diabetic groups, 84.2% were obese compared to 75.7% of the nondiabetics (p = 0.043), and this is consistent with Ahmed et al. [19] study, who reported that the modifiable CVD risk factors are high where obese patients constitute 52.6%, whereas abdominal obesity constitutes 65.5%. The most common risk factors for CVD were physical inactivity (74%) and overweight/obesity (25%/29%), which was reported in a study done by Kalaf et al. [22] in Al-Qassim from 2012 to 2014. A study done on Gulf Region by Aljefree and Ahmed [12] reported that the prevalence of overweight and obesity ranged from 31.2% to 43.3% and 22% to 34.1% in males and from 28% to 34.3% and 26.1% to 44% in females, respectively. In this study, the total cigarette smoker is 30.7%, which is 20.7% among diabetics compared to 50% of nondiabetic groups (p = 0.001). This is compatible with Al-Nozha et al. [23] study from 1995 to 2000, which reported that the overall prevalence of smoking among Saudis was 12.8%. In a study conducted by Aljefree and Ahmed [12] in Gulf countries, reported smoking more in males (13.4%–37.4%) than in females (0.5%–20.7%). In this study, the total hypertensive patients were 66% this is similar to Al-Nozha et al. [24] study, who reported that the prevalence of hypertension (HTN) in Saudi population was 26.1%. In our study, HTN was higher among diabetic patients 78% compared to 42.7% of non-diabetic (p = 0.001), and this is similar to a study done by Al Slail et al. [13], who reported that 45% of diabetic patients had hypertension as an additional risk for CVD. Another study conducted by AlNemer et al. [21], in KSA from December 2005 to December 2007, reported that diabetic patients had higher risk factor (hypertension) prevalence (40.2%). In the Gulf Region, a study done by Aljefree and Ahmed [12] reported the prevalence of hypertension (26.0%–50.7%) among adults. In our study, we found the total hyperlipidemia was 23.9% and this is compatible with Al-Nozha et al. [28] study between 1995 and 2000 in KSA; the prevalence of hypercholesterolemia was 54% among adults. Hyperlipidemia was 29.1% among diabetic patients compared to 13.6% of nondiabetic patients, and this is consistent with AlNemer et al. [21] study in KSA from December 2005 to December 2007, which reported that diabetic patients had higher risk factor (hyperlipidemia) prevalence (31.4%). A study performed by Al Slail et al. [13] reported that 77% of diabetic patients had elevated LDL concentrations. The renal disease is considered as a risk factor of ACS; in our study, it was 5.4% among diabetic groups compared to 7.8% of nondiabetic groups; and there was no significant difference (p = 0.421). This is consistent with a study done by Chang et al. [25] in Taiwan from 2000 to 2007 and reported that the chronic kidney disease was associated with a higher risk of ACS than DM (AHR: 1.43 [1.27–1.60] vs. 1.25 [1.22–1.29]). Table 4 shows catheterization and echocardiogram findings among diabetic and nondiabetic patients admitted to the cardiac department in ACH. In our study, the diagnostic procedure percutaneous coronary intervention showed that 86% of patients had ischemia; of them, 53% were diabetics with triple vessel disease compared to 45.9% of nondiabetics, 10.8% had mild CAD, and 3.2% was normal. This is compatible with a study done by AlNemer et al. [21], which reported that diabetic patients had a severe three-vessel disease or significant left main stem coronary disease, which was 41.91% in diabetic group, whereas 27.41% in nondiabetic (p = <0.001). In KSA, another study done by Al-Murayeh et al. [17] reported that coronary angiography was normal in 9.3% of the young population, whereas 14% had mild CAD (less than 50% stenosis). In our study, the ejection fraction among diabetic patients was 45.4% ± 11.6% compared to 48.6% ± 11.2% of nondiabetics, and This is consistent with a study done by AlNemer et al. [21], who reported diabetic patients more likely to present with significant left ventricular systolic dysfunction and multi-vessel disease compared to non-diabetic (40.2% vs. 31.4%, p < 0.001). Hence, diabetic patients were more likely to have significant left ventricular systolic dysfunction. Table 5 shows the outcome of MI in diabetic and nondiabetic patients admitted to the cardiac department in ACH. In our study, the outcome of majority of the patients was improved by 95.4%, whereas the death rate in diabetic patients was 6.4% compared to only one case of nondiabetic patients. This is compatible with AlNemer et al. [21], which reported that the adjusted OR for inhospital mortality in diabetic patients with ACS was 1.83 (95% CI, 1.02–3.30, p = 0.042). A study performed by AlHabib et al. [26] in Saudi Arabia from December 2005 to July 2006 reported that the inhospital mortality rate was 5% among adults with ACS. Condition of the patients during follow-up among 57.7% of diabetic patients was symptomatic compared to 38.3% of nondiabetic patients, and this is reported in a study done by Cziraky et al. [27] during follow-up, in which 22.0% of ACS patients had subsequent cardiovascular events (26.2% type 2 diabetes and 19.0% of nondiabetes). The main symptoms among both the diabetic and nondiabetic groups were chest pain (40% vs. 78.9%) followed by SOB (39.1% vs. 21.1%), respectively, and this is congruous with a study done by AlNemer et al. [21], which reported that diabetic patients with ACS were more likely to develop recurrent MI OR = 1.75 (1.05–2.94), p = 0.0316. A prospective and observational study done by Islam et al. [16] reported that diabetic patients experienced more recurrent ischemia as the outcome than nondiabetics (24% vs. 16.67%, p = 0.0524). Irrespective that the study covers the Aseer region population, but we covered only one hospital (main hospital) and not all hospitals due to the difficulty of the nature and wide area distribution of the Aseer region. First, based on the records, data were incomplete in some cases, but the main variable data were nearly complete. Follow-up also helped in having some attritions, especially among improved patients, which may overestimate the reverse outcome rate.

Table 5. Outcome of ACS diabetic and nondiabetic patients admitted to the cardiac department in ACH, Abha, Saudi Arabia.

Outcome Group Total p
Nondiabetics Diabetics
No. % No. % No. %
Fate Patient improved 102 99.0% 190 93.6% 292 95.4% 0.032*
Died 1 1.0% 13 6.4% 14 4.6%
Condition on follow-up Asymptomatic 30 61.2% 47 42.3% 77 48.1% 0.028*
Symptomatic 19 38.8% 64 57.7% 83 51.9%
Symptoms SOB 4 21.1% 25 39.1% 29 34.9% 0.008*
Chest pain 15 78.9% 26 40.6% 41 49.4%

Conclusions

After finishing our study, we concluded that there were significant differences between diabetic and nondiabetic patients in many clinical areas considering MI including clinical presentations, risk factors distribution, and clinical outcomes. Diabetic patients with MI have a greater prevalence of obesity, abdominal obesity, smoking, hyperlipidemia, and hypertension. Furthermore, diabetic patients had a higher prevalence of abnormal cardiac presentations including SOB and even ECG abnormalities. Complications including atrial fibrillations and arrhythmia were more recorded among these patients. The death rate was higher among diabetic patients than nondiabetics.


List of Abbreviations

BMI Body mass index
ECG Electrocardiogram
JVP Jugular venous pressure
Mild CAD Mild coronary artery disease
MI Myocardial infraction
NSTEMI Non ST-elevated myocardial infarction
PND Paroxysmal nocturnal dyspnea
SOB shortness of breath
STEMI ST-elevated myocardial infarction

Conflict of interest

The authors declare that there is no conflict of interest regarding the publication of this article.


Funding

None.


Consent for publication

Informed consent was obtained from all the participants.


Ethical Approval

Research Ethics Committee, King Khalid University, Abha, Saudi Arabia. REC # 2017-02-02.


Author details

Walaa A Aldarwish1, Ali A Alqarni2, Abdulrahman A Medawi1, Afnan Z Alhwaishel1, Amani H AbuHassan1, Baqer A. Aldarwish3

  1. College of Medicine, King Khalid University, Abha, Saudi Arabia
  2. Cardiology Department, Aseer Central Hospital, Abha, Saudi Arabia
  3. Collage of Medicine, Al-Baha University, Al-Baha, Saudi Arabia

References

  1. American Diabetes Association. Diabetes Statistics 2015. [cited 2015 Jun 29]. http://www.diabetes.org/diabetes-basis/diabetes-statistics/
  2. Gomez-Arbelaez D, Sánchez-Vallejo G, Perez M, Garcia RG, Arguello JF, Peñaherrera E, et al. Hyperglycaemia is associated with worse outcomes in Latin-American individuals with acute myocardial infarction. Clin Investig Arterioscler. 2016;28(1):9–18. https://doi.org/10.1016/j.arteri.2015.09.003
  3. Peterson PN, Spertus JA, Magid DJ, Masoudi FA, Reid K, Hamman RF, et al. The impact of diabetes on one-year health status outcomes following acute coronary syndromes. BMC Cardiovasc Disord. 2006;6:41. https://doi.org/10.1186/1471-2261-6-41
  4. Anselmino M, Bartnik M, Malmberg K, Rydén L. Euro Heart Survey Investigators. Management of coronary artery disease in patients with and without diabetes mellitus. Acute management reasonable but secondary prevention unacceptably poor: a report from the Euro Heart Survey on Diabetes and the Heart. Eur J Cardiovasc Prev Rehabil. 2007;14(1):28–36. https://doi.org/10.1097/01.hjr.0000199496.23838.83
  5. Patel PA, Cubbon RM, Sapsford RJ, Gillott RG, Grant PJ, Witte KK, et al. An evaluation of 20-year survival in patients with diabetes mellitus and acute myocardial infarction, Int J Cardiol. 2016;203:141–4. https://doi.org/10.1016/j.ijcard.2015.10.094
  6. Stone PH, Muller JE, Hartwell T, York BJ, Rutherford JD, Parker CB, et al. The effect of diabetes mellitus on prognosis and serial left ventricular function after acute myocardial infarction: contribution of both coronary disease and diastolic left ventricular dysfunction to the adverse prognosis. J Am Coll Cardiol. 1989;14:49–57. https://doi.org/10.1016/0735-1097(89)90053-3
  7. Rousan TA, Pappy RM, Chen AY, Roe MT, Saucedo JF. Impact of diabetes mellitus on clinical characteristics, management, and in-hospital outcomes in patients with acute myocardial infarction (from the NCDR). Am J Cardiol. 2014;114(8):1136–44. https://doi.org/10.1016/j.amjcard.2014.07.031
  8. Hryhoriy K. Peculiarities of heart rate in the patients with unstable angina and non-ST elevation myocardial infarction and concomitant diabetes mellitus type 2.Wiad Lek. 2016;69(3pt 2):524–6.
  9. Awad HH, Tisminetzky M, Metry D, McManus D, Yarzebski J, Gore JM, et al. Magnitude, treatment, and impact of diabetes mellitus in patients hospitalized with non-ST segment elevation myocardial infarction: a community-based study. Diab Vasc Dis Res. 2016;13(1):13–20. https://doi.org/10.1177/1479164115609027
  10. Umar H, Mattiullah K, Nasir Hussain SK, Nasir A, Waqar AM, Faisal Iftikhar K, et al. Frequency of newly diagnosed diabetes mellitus in patients with acute myocardial infarction. J Ayub Med Coll Abbottabad. 2014;26(3):368–70.
  11. Al-Nozha MM, Al-Maatouq MA, Al-Mazrou YY, Al-Harthi SS, Arafah MR, Khalil MZ, et al. Diabetes mellitus in Saudi Arabia. Saudi Med J. 2004;25(11):1603–10.
  12. Aljefree N, Ahmed F. Prevalence of cardiovascular disease and associated risk factors among adult population in the Gulf Region: a systematic review. Adv Public Health. 2015;2015:23. https://doi.org/10.1155/2015/235101
  13. Al Slail FY, Abid O, Assiri AM, Memish ZA, Ali MK. Cardiovascular risk profiles of adults with type-2 diabetes treated at urban hospitals in Riyadh, Saudi Arabia. J Epidemiol Glob Health. 2016;6(1):29–36. https://doi.org/10.1016/j.jegh.2015.07.004
  14. Ahmed S, Khan A, Ali SI, Saad M, Jawaid H, Islam M, et al., Differences in symptoms and presentation delay times in myocardial infarction patients with and without diabetes: a cross-sectional study in Pakistan. Indian Heart J. 2018;70(2):241–5. https://doi.org/10.1016/j.ihj.2017.07.013
  15. Albackr HB, Alhabib KF, Ullah A, Alfaleh H, Hersi A, Alshaer F, et al., Prevalence and prognosis of congestive heart failure in Saudi patients admitted with acute coronary syndrome (from SPACE registry). Coron Artery Dis. 2013;24(7):596–601. https://doi.org/10.1097/MCA.0b013e328364d98f
  16. Islam MN, Mahmud AA, Pandit H, Bhuiyan AS. Presentation and in-hospital outcome in first attack of acute coronary syndrome among diabetic and non-diabetic people. Mymensingh Med J. 2015;24(3):471–9.
  17. Al-Murayeh MA, Al-Masswary AA, Dardir MD, Moselhy MS, Youssef AA. Clinical presentation and short-term outcome of acute coronary syndrome in native young Saudi population. J Saudi Heart Assoc. 2012;24(3):169–75. https://doi.org/10.1016/j.jsha.2012.03.001
  18. Birnbaum Y, Wilson JM, Fiol M, de Luna AB, Eskola M, Nikus K. ECG diagnosis and classification of acute coronary syndromes. Ann Noninvasive Electrocardiol. 2014;19(1):4–14. https://doi.org/10.1111/anec.12130
  19. Ahmed AM, Hersi A, Mashhoud W, Arafah MR, Abreu PC, Al Rowaily MA, et al. Cardiovascular risk factors burden in Saudi Arabia: the Africa Middle East cardiovascular epidemiological (ACE) study. J Saudi Heart Assoc. 2017;29(4):235–43. https://doi.org/10.1016/j.jsha.2017.03.004
  20. Alharthi FS, Alrahimi JS, Alotaibi AA, Alhamdi DA, Ibrahim BM, Badeeb YA. Prevalence of undiagnosed cardiovascular risk factors in adults aged 20–40: a cross-sectional study in 2016 in Jeddah, Saudi Arabia. Cardiol Res. 2017;8(3):111. https://doi.org/10.14740/cr566w
  21. AlNemer KA, AlFaleh HF, AlHabib KF, Ullah A, Hersi A, AlSaif S, et al. Impact of diabetes on hospital adverse cardiovascular outcomes in acute coronary syndrome patients: data from the Saudi project of acute coronary events. J Saudi Heart Assoc. 2012;24(4):225–31. https://doi.org/10.1016/j.jsha.2012.08.002
  22. Kalaf H, AlMesned A, Soomro T, Lasheen W, Ewid M, Al-Mohaimeed AA. Cardiovascular disease risk profile among young Saudi women of Al-Qassim, Saudi Arabia: a cross-sectional study. Int J Health Sci. 2016;10(1):29. https://doi.org/10.12816/0031214
  23. Al-Nozha MM, Al-Mazrou YY, Arafah MR, Al-Maatouq MA, Khalil MZ, Khan NB, et al. Smoking in Saudi Arabia and its relation to coronary artery disease. J Saudi Heart Assoc. 2009;21(3):169–76. https://doi.org/10.1016/j.jsha.2009.06.007
  24. Al-Nozha MM, Abdullah M, Arafah MR, Khalil MZ, Khan NB, Al-Mazrou YY, et al., Hypertension in Saudi Arabia. Saudi Med J. 2007;28(1):77–84.
  25. Chang YT, Liu CC, Tsai LM, Li CY, Sung JM. Separate and joint effects of diabetes mellitus and chronic kidney disease on the risk of acute coronary syndrome: a population-based cohort study. Medicine (Baltimore). 2014;93(28):e261. https://doi.org/10.1097/MD.0000000000000261
  26. AlHabib KF, Hersi A, AlFaleh H, Kurdi M, Arafah M, Youssef M, et al. The Saudi project for assessment of coronary events (SPACE) registry: design and results of a phase I pilot study. Can J Cardiol. 2009;25(7):e255–8. https://doi.org/10.1016/S0828-282X(09)70513-6
  27. Cziraky MJ, Reddy VS, Luthra R, Xu Y, Wilhelm K, Power TP, et al. Clinical outcomes and medication adherence in acute coronary syndrome patients with and without type 2 diabetes mellitus: a longitudinal analysis 2006–2011. J Manag Care Spec Pharm. 2015;21(6):470–7. https://doi.org/10.18553/jmcp.2015.21.6.470
  28. Al-Nozha MM, Arafah MR, Al-Maatouq MA, Khalil MZ, Khan NB, Al-Marzouki K, et al. Hyperlipidemia in Saudi Arabia. Saudi Med J. 2008;29(2):282–7.


How to Cite this Article
Pubmed Style

Aldarwish WA, Alqarni AA, Medawi AA, Alhwaishel AZ, AbuHassan AH, Aldarwish BA. Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. IJMDC. 2020; 4(3): 620-628. doi:10.24911/IJMDC.51-1574537501


Web Style

Aldarwish WA, Alqarni AA, Medawi AA, Alhwaishel AZ, AbuHassan AH, Aldarwish BA. Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. http://www.ijmdc.com/?mno=75028 [Access: March 29, 2020]. doi:10.24911/IJMDC.51-1574537501


AMA (American Medical Association) Style

Aldarwish WA, Alqarni AA, Medawi AA, Alhwaishel AZ, AbuHassan AH, Aldarwish BA. Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. IJMDC. 2020; 4(3): 620-628. doi:10.24911/IJMDC.51-1574537501



Vancouver/ICMJE Style

Aldarwish WA, Alqarni AA, Medawi AA, Alhwaishel AZ, AbuHassan AH, Aldarwish BA. Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. IJMDC. (2020), [cited March 29, 2020]; 4(3): 620-628. doi:10.24911/IJMDC.51-1574537501



Harvard Style

Aldarwish, W. A., Alqarni, . A. A., Medawi, . A. A., Alhwaishel, . A. Z., AbuHassan, . A. H. & Aldarwish, . B. A. (2020) Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. IJMDC, 4 (3), 620-628. doi:10.24911/IJMDC.51-1574537501



Turabian Style

Aldarwish, Walaa A, Ali A Alqarni, Abdulrahman A Medawi, Afnan Z Alhwaishel, Amani H AbuHassan, and Baqer A. Aldarwish. 2020. Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 620-628. doi:10.24911/IJMDC.51-1574537501



Chicago Style

Aldarwish, Walaa A, Ali A Alqarni, Abdulrahman A Medawi, Afnan Z Alhwaishel, Amani H AbuHassan, and Baqer A. Aldarwish. "Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia." International Journal of Medicine in Developing Countries 4 (2020), 620-628. doi:10.24911/IJMDC.51-1574537501



MLA (The Modern Language Association) Style

Aldarwish, Walaa A, Ali A Alqarni, Abdulrahman A Medawi, Afnan Z Alhwaishel, Amani H AbuHassan, and Baqer A. Aldarwish. "Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia." International Journal of Medicine in Developing Countries 4.3 (2020), 620-628. Print. doi:10.24911/IJMDC.51-1574537501



APA (American Psychological Association) Style

Aldarwish, W. A., Alqarni, . A. A., Medawi, . A. A., Alhwaishel, . A. Z., AbuHassan, . A. H. & Aldarwish, . B. A. (2020) Myocardial infarction risk factors and outcome among diabetic and nondiabetic patients at the high altitude of Saudi Arabia. International Journal of Medicine in Developing Countries, 4 (3), 620-628. doi:10.24911/IJMDC.51-1574537501