Does Diabetes Mellitus Make a Difference in Symptom Presentation of Patients with Acute Myocardial Infarction?

Purpose:

The study aimed to compare the differences in symptom presentation between diabetic and non-diabetic patients with acute myocardial infarction (AMI), and to examine the impact of diabetes on symptom presentation in AMI patients.

Methods:

A consecutive sample of patients with a confirmed diagnosis of AMI was recruited from the cardiac units of three regional hospitals in Hong Kong. Data collection was conducted through face-to-face interview. The validated Chinese version of the Symptoms of Acute Coronary Syndromes Inventory (SACSI-C) was used for symptom assessment.

Results:

A total sample of 397 patients was recruited, with the mean age of 63.3 ± 12.7 years. Diabetes (32%) was the second most prevalent comorbidity in the sample. Diabetic patients were less likely to present with chest pain (p<0.0001) and sweating (p=0.001). Conversely, they were more likely to present with shortness of breath (p=0.001) and difficulty in breathing (p=0.003) than the non-diabetic patients. Overall, the diabetic patients were more likely to present with atypical AMI symptoms (p<0.0001). The result of multivariable logistic regression analysis showed that diabetes was an independent predictor of atypical symptom presentation in AMI patients, with an odds ratio of 2.37 (95% confidence interval: 1.36–4.12; p=0.002).

Conclusion:

In summary, diabetic patients have a 2.4-fold increased risk for atypical symptom presentation than that of non-diabetic patients. Health professionals should remain vigilant at recognizing atypical AMI presentation in diabetic patients. A tailor-made educative intervention should be directed to them.