engleski

SILENT ACUTE MYOCARDIAL INFARCTION IN DIABETIC PATIENTS IN EMERGENCY MEDICINE

Silent acute myocardial infarction occurs commonly in diabetic patients. Currently, it is not fully understood whether altered perception of ischemia also predisposes atypical presentations, and therefore leads to under-diagnosing the acute myocardial infarction (AMI) in diabetic patients. In this study, we tried to determine whether chest pain in AMI occurred less frequently in diabetic patients. Methods: In this retrospective study, we included patients admitted from April 2014 to November 2019. Data were collected using eHitna and BIS as the nation-wide programs for patient tracking and registry in Croatia. All patients included in the study had initially called Department of Emergency Medicine of Brod-Posavina County, which then resulted in an intervention. Patients were then transferred to Dr Josip Benčević General Hospital, where they were hospitalized. All patients had discharge letters with the diagnosis specifi ed by ICD- 10 classifi cation as I21 spectrum (I21.0, I21.1, I21.2, I21.3, I21.4, I21.9), i.e. AMI. Results: In this study, we included 180 Patients having suffered AMI who were hospitalized and treated. There were 35 (19%) diabetic patients (DP) and 145 (81%) non- DIabetic patients (non-DP), Chest pain was absent in nine (26%) DP and 13 (9%) non-DP (p=0.007). There was no difference in sex distribution within the two groups, with 60% and 68% male patients in DP and non-DP, respectively (p=0.395). The mean patient age was significantly different between the two groups, i.e. 69 years in DP and 64 years in non-DP (p=0.034). Discussion: AMI in diabetic patients could have altered clinical presentation, which has often been researched therefore. Some researchers have reported that atypical or silent presentations are more frequent in DP with AMI, whereas others found no differences when compared to non-DP. In our study, absence of chest pain as a Characteristic of silent AMI was experienced by 17% more DP as compared to non-DP, suggesting that DM infl uences clinical presentation of AMI. It is important to emphasize the importance of such fi ndings in emergency medicine where patients often describe their various symptoms. The mean age of DP having suffered AMI was signifi cantly higher (even up to 5 years) in comparison to non-DP. Despite the fact that DM is a risk factor for developing AMI, this fi nding could be explained by the fact that DM is more common in elderly population. Conclusion: Chest pain occurs signifi cantly less frequently in DP that develop AMI than in non-DP. Therefore, DP have a higher probability of developing silent AMI.

silent acute myocardial infarction, diabetes mellitus, chest pain, diabetic patients

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