Acute coronary syndromes amongst type 2 diabetics with ischaemic electrocardiograms presenting to accident and emergency department of a Kenyan tertiary institution

Abstract

Objective: To determine the prevalence of acute coronary syndromes among type 2 diabetic patients presenting to Accident and Emergency department. Design: Prospective cross-sectional study. Setting: Kenyatta National Hospital, a tertiary teaching and referral hospital. Subjects: Type 2 diabetic patients with ischaemic electrocardiograms (ECG). Main outcome measures: Demographics, clinical symptoms, cardiovascular status and risk factors - central obesity, hypertension, dyslipidaemia, smoking. Results: From 12,307 accident and emergency attendees, 400 ( 33%) diabetics aged >30 years were screened with a resting ECG and 95 (24%) with ischaemic ECG were recruited; age range 41-87 years, 60% were male; diabetes duration ranged 0-30 years with 8.4% being newly diagnosed. The commonest enrolling ECG feature was nonspecific ST-T changes. The commonest presenting complaint were fatigue and dyspnoea. Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevated LDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulin and OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) were classified as acute coronary syndrome (ACS); 29 ( 30.5%) acute myocardial infarction (ACS-AMI) and five (5.2%) unstable angina (ACS-UA). Majority (79.4%) of the ACS presented more than six hours after symptom onset and majority had features of acute left ventricular failure. Conclusions: Acute coronary syndrome accounted for 35% of the morbidity in type 2 diabetics with ischaemic ECG’s presenting to KNH accident and emergency department;
patients presented late and 80% were not on CAD prophylactic therapy.