Do diabetic patients have higher in-hospital complication rates when admitted from the emergency department for possible myocardial ischemia?

Objective: To compare in-hospital complication rates for diabetic and nondi abetic patients admitted from the emergency department (ED) for possible my ocardial ischemia. Methods: This was a prospective, observational study of consecutive consenting patients presenting to a suburban university hospita l ED during study hours with typical and atypical symptoms consistent with cardiac ischemia. Demographic, historical, and clinical data were recorded by trained research assistants using a standardized, closed-question, data collection instrument. Inpatient records were reviewed by trained data abst ractors to ascertain hospital course and occurrence of complications. Final discharge diagnosis of acute myocardial infarction (AMI) was assigned by W orld Health Organization criteria. Categorical and continuous data were ana lyzed by chi-square and t-tests, respectively. All tests were two-tailed wi th alpha set at 0.05. Results: There were 1,543 patients enrolled who did n ot have complications at initial presentation; 283 were diabetic. The rule- in rate for AMI was 13.8% for nondiabetic patients and 17.7% for diabetic p atients (p = 0.09). Times to presentation were similar for nondiabetic vs d iabetic patients [248 minutes (95% CI = 231 to 266) vs 235 minutes (95% CI = 202 to 269); p = 0.32]. Nondiabetic patients tended to be younger [56.6 y ears (95% CI = 55.8 to 57.4) vs 61.6 years (95% CI = 60.2 to 63.1); p = 0.0 01] and were less likely to be female (34.3%, vs 48.1%; p = 0.001) The two groups had similar prevalences for initial electrocardiograms diagnostic fo r AMI (5.5% vs 7.4%; p = 0.21). There was no significant difference between nondiabetic and diabetic patients for the occurrence of the following comp lications after admission to the hospital: congestive heart failure (1.3% v s 1.1%, p = 0.77); nonsustained ventricular tachycardia (VT) (1.3% vs 1.2%, p = 0.93); sustained VT (1.2% vs 1.1%, p = 0.85); supraventricular tachyca rdia (1.7% vs 3.2%, p = 0.12); bradydysrhythmias (1.9% vs 1.1%, p = 0.33); hypotension necessitating the use of pressors (0.9% vs 1.1%, p = 0.76); car diopulmonary resuscitation (0.2% vs 0.7%, p = 0.10); and death (0.3% vs 0.7 %, p = 0.34). One or more complications occurred with similar frequencies f or patients in the two groups (6.3% vs 5.7%; p = 0.70). Conclusions: No sta tistically significant difference was found in the postadmission complicati on rates for initially stable diabetic vs nondiabetic patients admitted for possible myocardial ischemia. Based on these results, the presence or abse nce of diabetes as a comorbid condition does not indicate a need to alter a dmitting decisions with respect to risk for inpatient complications.