Does type 2 diabetes mellitus influence characters of patients with ST elevation myocardial infarction

yocardial infarction", Z Kardiol., 
Vol. 92(10), pp. 817-824. 
[2]. Gradišer M., Dilber D., Cmrecnjak et al. (2015), "Comparison of the hospital arrival time and differences in pain quality between Diabetic and Non-Diabetic 
STEMI patients", International Journal of Environmental Research and Public Health, vol. 12, pp. 1387-1396. 
Gradiser M.: moderate to severe angina among DM < non DM [2] 
CLINICAL FEATURES 
23 
RESULTS AND DISCUSSION 
Features DM 
n = 31 
Non DM 
n = 80 
Total 
n = 111 
p 
Dyspnea, n (%) 26 (83.87) 67 (83.75) 93 >0.05 
Diaphoresis, n (%) 13 (41.94) 49 (61.25) 62 >0.05 
Nausea/vomitng, n (%) 19 (61.29) 27 (33.75) 46 < 0.01 
palpitation, n (%) 3 (9.68) 19 (23.75) 22 >0.05 
Syncope, n (%) 1 (3.23) 3 (3.75) 4 >0.05 
Hypotension, n (%) 4 (12.90) 5 (6.25) 9 >0.05 
Mental disorder, n (%) 5 (16.13) 4 (5.00) 9 >0.05 
GENERAL FEATURES 
Kentsch: Severe dyspnea among DM higher[1].Richman P.B.: no differenct[2]. 
RR = 1.8 
(KTC 95%: 1.2-2.8) 
[1]. Kentsch M., Rodemerk U., Gitt A.K. et al (2003), "Angina intensity is not different in diabetic and non-diabetic patients with acute myocardial infarction",Z Kardiol., Vol. 92(10), 
pp. 817-824. 
[2]. Richman P.B, Brogan G.X, Nashed A.N et al. (1999), "Clinical characteristics of diabetic vs nondiabetic patients who "rule-in" for acute myocardial infarction",Academic 
 Emergency Medicine, Vol. 6(7), pp. 719-723. 
24 
RESULTS AND DISCUSSION 
GENERAL FEATURES 
0
20
40
60
80
100
Killip I, II Killip III, IV
ĐTĐ
Không ĐTĐ
Chart 2. Killip classification of study groups 
77.42% 
97.50% 
22.58% 
3.75% 
p< 0.01 
DM 
No DM 
RR= 6 (KTC 95%: 1.7 – 21.8) 
Pavlovíc J. [1]; Timmer J.R. [2]: Killip 1 classification were more prevalent among Diabetic 
[1]. Pavlovid J., Đin đic B., Pavlovic A. et al. (2013), "The influence of diabetes mellitus on morbidity and mortality in patients with acute myocardial infarction in Jablanica district", 
Acta Medica Medianae, Vol. 52(3), pp. 5-11. 
[2]. Timmer J.R., Ottervangera J.P., Thomasa K. et al. (2004), "Long-term, cause-specific mortality after myocardial infarction in diabetes", European society of cardiology, 
Vol. 25, pp. 926-931. 
2525 
RESULTS AND DISCUSSION 
GENERAL FEATURES 
0 20 40 60 80
Thành trước và bên cao 
Thành dưới 
Thất phải 
không ĐTĐ
ĐTĐ
Chart 5. Site of myocardial infarcction on ECG 
61.29% 
60.00% 
22.58% 
33.75% 
16.13% 
6.25% 
p >0.05 
Right Ventricle 
Inferior region 
Anterior or lateral region 
No DM 
DM 
Analogous to Abass F. [1], Iqbal M.J. [2] 
Hung Phạm Văn [3]: LAD 46.3%, RCA 35.9% 
[1]. Abass F., Mufti T.A., Hafizullah M. et al. (1999), "Effect of diabetic status on morbidity and mortality following acute myocardial infarction", Journal of Postgraduate 
Medical Institute, Vol. 13(1), pp. 125-131. 
[2]. Iqbal M.J., Rauf M.A., Faheem M. et al. (2008), "Study on ST-Segment elevation acute myocardial infarction in diabetic and non diabetic patients", Pak J Med Sci., 
Vol. 24(6), pp. 786-791. 
[3]. Phạm Văn Hùng, Hồ Văn Phước, Nguyễn Quốc Việt và cs (2014), "Đánh giá kết quả chụp và can thiệp động mạch vành qua da tại bệnh viện Đà Nẵng",Tạp chí 
Tim mạch học Việt Nam, Số 68, tr. 117-122. 
26 
RESULTS AND DISCUSSION 
RESULTS AND DISCUSSION 
Table 6. Cardiac enzymes concentration by study groups 
 Mean Median SD Bottom 
Quartile 
Upper 
Quartile 
CK 
(U/L) 
DM 1242.19 636.00 1376.59 230.00 1430.75 
Non DM 1933.83 1125.5 2300.8 272.00 2512.00 
CKMB 
(ng/mL) 
DM 63.54 26.42 88.75 6.62 79.60 
Non DM 131.36 59.75 145.75 8.99 218.50 
27 
GENERAL FEATURES 
Chart 7 Dyslipidemia phenostypes 
Dyslipidemia phenotype 
DM 
n = 31 
DM 
n = 80 
Total 
n = 111 
P 
Normal , n (%) 5 (16.13) 10 (12.50) 15 (13.51) 
>0.05 
TG alone +/- HDL-c alone, n (%) 8 (25.81) 8 (10.00) 16 (14.41) 
LDL-c alone +/- TC , n (%) 5 (16.13) 24 (30.00) 29 (26.13) 
Mixed disorder, n (%) 13 (41.93) 38 (47.50) 51 (45.95) 
28 
RESULTS AND DISCUSSION 
RESULTS 
Table 8. correlation between clinical and laboratory factors and 
death within 7 days since admission 
29 
Variable P OR 95% CI 
Age ≥60 ys 0.69 
Gender 0.52 
Smoking 0.57 
Diabetes mellitus <0.01 37.62 4.56-310.66 
Dyslipidemia 0.16 
Overweight <0.01 8.8 2.32-33.32 
Pulse 0.31 
Systolic BP <0.01 - - 
High Killip class (III, IV) <0.01 56.58 10.52-304.22 
EF<40% <0.01 9.46 2.31-38.68 
Anterior region MI 0.02 0.22 0.055-0.882 
PCI 0.03 0.1 0.005-1.68 
RESULTS AND DI CUSSION 
RESULTS 
Table 9. logistic regression analysis for death prediction that 
occurred within 7 days since admission 
Variable B p OR 95% CI 
Diabetes mellitus 3.46 <0.01 31.7 2.77 – 363.9 
Systolic blood pressure -0.04 <0.001 0.96 0.95 – 0.98 
High Killip classification 
(class III, IV) 
2.52 <0.05 12.4 1.16 – 132.9 
30 
RESULTS AND DI CUSSION 
DISCUSSION 
- GUSTO-I [1], GUSTO-III [2], Reynolds H.R. et al.[3], Hasdai D. et al.[4]: 
Killip class, systolic blood pressure. 
- Wu A.H. et al.[5]: heart failure with Killip II, III conferred higher 
in-hospital mortality rate than those without heart failure (21.4% 
với 7.2%). 
[1]. The GUSTO Investigators (1993), "An international randomized trial comparing four thrombolytic strategies for acute myocardial infarction", The New 
England Journal of Medicine, Vol. 329, pp. 673-682. 
[2]. The GUSTO III Investigators (1997), "A comparision of reteplase with Alteplase for acute myocardial infarction", The New England Journal ofMedicine, 
 Vol. 337, pp. 1118-1123. 
[3]. Reynolds H.R. and Hochman J.S. (2008), "Cardiogenic shock: current concepts and improving outcomes", Circulation 2008, Vol. 117, pp. 686-697. 
[4]. Hasdai D., Califf R.M., Thompson T.D. et al. (1999), "Predictors of cardiogenic shock after thrombolytic therapy for acute myocardial infarction", Journal of 
 the American College of Cardiology, Vol. 35(1), pp. 136-143. 
[5]. Wu A.H., Parsons L., Every N.R. et al. (2002), "Hospital outcomes in patients presenting with congestive heart failure complicating acute myocardial 
 infarction: A report from the Second National Registry of Myocardial Infarction (NRMI-2)", Journal of American College of Cardiology, Vol. 40(8), pp. 1389-1394 
31 
RESULTS AND DISCUSSION 
DISCUSSION 
32 
• Vinh Ngo Hang[1]: prevalence of multivessel diseases in Diabetic pts 
were higher than that in non Diabetic pts. 
• Timmer J.R. et al: post STEMI mortality rates among Diabetes were 
higher than those of non-diabetes : OR 1.14 (1.05 – 1.17)[2]. 
[1]. Ngô Hàng Vinh, Phạm Nguyễn Vinh, Phạm Hòa Bình và cs (2011), "Khảo sát các yếu tố nguy cơ tim mạch, tổn thương động mạch vành ở bệnh nhân có tuổi bị nhồi máu 
cơ tim cấp, có hoặc không có đái tháo đường", Tạp chí Y học TP. Hồ Chí Minh. Tập 15(1), tr. 200-206. 
[2]. Timmer J.R., Ottervangera J.P., Thomasa K. et al. (2004), "Long-term, cause-specific mortality after myocardial infarction in diabetes", European society of cardiology, 
Vol. 25, pp. 926-931. 
RESULTS AND DISCUSSION 
DISCUSSION 
33 
RESULTS AND DISCUSSION 
DISCUSSION 
34 
On average DM doubles CVD risk 
Emerging risk factor collaboration 
RESULTS AND DISCUSSION 
DISCUSSION 
- Lopez-de-Andres A.: DM patients with AMI had higher in-
hospital mortality (OR: 1.14; KTC 95%: 1.05 – 1.17) [1]. 
- Koo B.K.: DM patients without angina had CAD proportion 
similar to that of non DM with angina [2]. 
- Haffner S.M.: DM patients without previous MI had high risk of 
MI as non DM patients with old MI [3]. 
[1]. Lopez-de-Andres A., Garcia R.J., Barrera V.H. et al (2014), "National trends over one decade in hospitalzation for acute myocardial infarction 
 among Spanish adults with type 2 diabetes: Cumulative incidence, outcomes and use of percutaneous coronary intervention", Plos one, Vol. 9(1), 
pp. 1-7. 
[2]. Koo B.K., Kim Y.G., Park K.S et al (2013), "Asymptomatic subjects with diabetes have a comparable risk of coronary artery disease to non-diabetic 
subjects presenting chest pain: a 4-year community-based prospective study", BMC Cardiovascular Disorders, Vol. 13, pp. 87-94. 
[3]. Haffner S.M., Lehto S., Ronnecmaa T. et al (1998), "Mortality from coronary heart disease in subjects with type 2 diabetes and in nondiabetic subjects 
with and without prior myocardial infarction", The New england Journal of Medicine, Vol. 339(4), pp. 229-234. 
35 
RESULTS AND DISCUSSION 
DISCUSSION 
36 
Glycemic continuum and Cardiovascular disease 
European Heart Journal (2013) 34, 3035–3087 
RESULTS AND DISCUSSION 
CONCLUSION 
1 
Symptom nausea/vomiting had higher rate among T2DM 
patients with RR=1.8 (95% CI: 1.2 – 2.8). 
Clinical symptoms : chest pain, dyspnea 
Do not differ between pts with and without T2DM. 
2 
3 Severe Killip classification on admission among 
T2DM patients were higher than those without T2DM 
with RR=6 (95% CI: 1.7 – 21.8). 
Low LVEF (< 40%) in T2DM patients was higher than that 
in patients without T2DM with RR=2.26 (95% CI: 1.26 – 4.05). 
4 
CLINICAL 
AND 
LABORA 
TORY 
FEATURES 
37 
CONCLUSIONS 
Diabetes Mellitus, Systolic BP and severe Killip class (class III, IV) were 
independent predictors of mortality within 07 days from admission 
1 
Prognostic mortality rate were with OR 31.7 (95% CI: 2.77 – 
363.9) among STEMI patients with T2DM. 
STEMI patients with severe Killip class (class III, IV) 
had times higher mortality rate with OR 12.4 
(95% CI: 1.16 – 132.9) than lighter Killip class. 
2 
3 
Systolic BP had inverse correlation with prognostic morality 
among STEMI. 
PROGNOSTIC 
 MORTALITY 
RATE WITHIN 
7 DAYS IN 
STEMI PTS 
38 
PROPOSAL 
In practice, one needs to evaluate clinical features including: 
- Blood pressure measurements 
- Killip class 
- screening diabetes mellitus 
For prognostic mortality among STEMI patients. 
39 
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