Effect of diabetes mellitus on the presentation and triage of patients with acute chest pain without known coronary artery disease

PURPOSE: Patients with diabetes and acute chest pain may be admitted to hos pitals more frequently than patients without diabetes because physicians su spect atypical presentations for ischemic heart disease. This study aimed t o determine whether the presentation of acute myocardial infarction and ris k for major cardiac complications differs among patients without known coro nary artery disease who do or do not have diabetes. PATIENTS AND METHODS: Data from an emergency department of an urban teachin g hospital on the medical histories, physical examinations, and electrocard iograms 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 less than or equal to 60 years old (51% versus 20%) and to have a history of hyperten sion (70% versus 35%) or high blood cholesterol (35% versus 19%). A dischar ge diagnosis of acute myocardial infarction was made in 25 diabetic (8%) an d 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 di abetes (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 ho spitalized (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 associa ted with a higher rate of hospitalization in this population, suggesting th at physicians have a lower threshold for admission to the hospital of patie nts with diabetes. Am J Med. 1998;105:500-505. (C) 1998 by Excerpta Medica, Inc.