Background: Coronary Artery Disease (CAD) is the leading cause of morbidity and mortality among those with diabetes mellitus. Screening, risk stratification and treatment can be delayed in the absence of symptoms or in those with atypical presentation. This study aimed to determine the frequency of other coronary risk factors, echocardiographic and angiographic abnormalities amongst diabetic patients with silent ischemia and with atypical symptoms.
Methods: A descriptive study conducted at the Philippine Heart Center from October 2009 to July 2011, including diabetic patients of at least 18 years old, admitted for acute coronary syndrome, who were asymptomatic or with atypical symptoms and resting ECG findings of Q waves, ST segment depression or elevation. Baseline clinical information, electrocardiogram, echocardiographic and angiographic results were obtained from the Acute Coronary Syndrome registry.
Results: Four hundred thirty-two patients diagnosed to have acute coronary syndrome, with 97 patients presenting with atypical symptoms and silent ischemia, with 56 (58%) male and 41 (42%) female. The mean age of patients was 67 years old. Eighty-four patients (19%) presented with atypical symptoms, 61% of which reported difficulty of breathing. On the other hand, 13 patients (4%) denied any symptoms. Thirty-three percent (33%) were overweight and former smokers among those with atypical MI; and 38% were likewise overweight among those without symptoms. Hypertension was the most common co-morbid condition. The most common site of involvement based on the ECG was the inferior wall (17%) for atypical MI, and the anterior wall (23%) for silent ischemia. Most of the patients in both atypical MI, and silent ischemia had an ejection fraction of >40% and diastolic dysfunction. In those with atypical MI, 46% had three-vessel involvement and in those with silent ischemia, 73% had three-vessel disease.
Conclusion: The clinical significance of this high-risk population could be similar to those symptomatic patients, and warrants further local prospective studies to elucidate attributes different from the Western population.