Acute coronary syndrome in a diabetic population--risk factors and clinical and angiographic characteristics.

INTRODUCTION: Diabetes is not only a risk factor for coronary artery disease but also influences its presentation and evolution. OBJECTIVES: The objective of this work is to define the risk factors, clinical and angiographic characteristics, and evolution of acute coronary syndrome in a population of diabetic patients. METHODOLOGY: We studied 521 patients suffering from acute coronary syndrome, consecutively hospitalized in the Cardiology Intensive Care Unit who underwent cardiac catheterization during their hospitalization, in terms of risk factors for coronary disease, pathology (unstable angina versus acute myocardial infarction), coronary morphology, left ventricular function, need for intervention during hospitalization, evolution and complications during one-year follow-up. The characteristics of the diabetic patients with acute coronary syndrome were compared to those of non-diabetic patients. RESULTS: Of the 521 patients suffering from acute coronary syndrome (391 male), 159 (30.5%) were diabetic. The diabetic patients suffering from acute coronary syndrome generally presented fewer risk factors for coronary artery disease, with a lower prevalence of smoking (p < 0.001), greater prevalence of family history of coronary artery disease (p < 0.01), more unstable angina and less acute myocardial infarction (both p < 0.001), than the nondiabetic patients. After the acute coronary syndrome the diabetic patients more frequently presented disease of the left anterior descending artery, left ventricular function was worse and there was a greater need for coronary artery bypass graft surgery and less percutaneous transluminal coronary angioplasty than in the non-diabetic patients (p < 0.05 for all). In terms of evolution, they presented greater complications and more mortality over a year (p < 0.05). CONCLUSION: Diabetes constitutes a powerful risk factor for coronary artery disease and its complications, and should therefore be taken into consideration in clinical approaches to this pathology.