Influence of diabetes on the outcome of acute coronary syndrome in Kuwait.

OBJECTIVES To describe the baseline characteristics and management of patients with and without diabetes mellitus (DM) hospitalized with acute myocardial infarction (AMI) and to assess the influence of DM on hospital outcomes and hospital mortality. SUBJECTS AND METHODS We analyzed data from a 6-month observational study (Kuwait Acute Coronary Syndrome Registry) of unselected patients admitted with a diagnosis of AMI over a period of 6 months, from December 2003 through May 2004. RESULTS Of 1,295 patients enrolled, 609 (47%) were diabetics and 686 (53%) were non-diabetics. Diabetics were more likely to have a past history of coronary artery disease, hypertension and left ventricular systolic dysfunction than non-diabetics. There was less use of beta-blockers and aspirin in diabetics as compared to non-diabetics (62 vs. 71% and 95.5 vs. 97.9%, p < 0.03, for beta-blockers and aspirin, respectively). Left ventricular failure and cardiogenic shock occurred more often in diabetics compared to non-diabetics (16 vs. 7% and 5 vs. 3%, p < 0.001, for left ventricular failure and shock, respectively). The mortality rate was 6% for diabetics and 2% for non-diabetics (p < 0.001). CONCLUSION DM is a major health problem among the adult population in Kuwait, and almost half the AMI population suffer from diabetes. Diabetic patients had higher rates of complications, especially left ventricular failure and cardiogenic shock, as compared to non-diabetic patients. The in-hospital mortality among diabetics with AMI was almost triple that of non-diabetics. The results of this study highlight the need to improve adherence to evidence-based treatment in diabetic patients with AMI.