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 2diabetic 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 andrisk 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 wererecruited; age range 41-87 years, 60% were male; diabetes duration ranged 0-30 yearswith 8.4% being newly diagnosed. The commonest enrolling ECG feature was nonspecificST-T changes. The commonest presenting complaint were fatigue and dyspnoea.Majority had three coronary artery disease (CAD) risk factors: obesity 86%, elevatedLDL 73% and hypertension 60%. Therapy in use was OHA 43%, insulin 42%, insulinand OHA 1%; prophylactic aspirin 14.7% and statins 8.4%. Thirty four (35.8%) wereclassified 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 ACSpresented more than six hours after symptom onset and majority had features of acuteleft ventricular failure.

Conclusions: Acute coronary syndrome accounted for 35% of the morbidity in type 2diabetics with ischaemic ECG’s presenting to KNH accident and emergency department;patients presented late and 80% were not on CAD prophylactic therapy.