Characteristics, management, and in-hospital outcomes of diabetic acute coronary syndrome patients in Oman

Objectives: To determine clinical characteristics, management, and in-hospital outcomes of diabetic and non-diabetic patients admitted with acute coronary syndrome (ACS) in Oman. Methods: Data were analyzed from 1583 consecutive patients admitted to various hospitals in Oman with ACS from May 8 to June 6, 2006, and from January 29 to June 29, 2007, as part of the Gulf RACE (Registry of Acute Coronary Events). The ACS patients were stratified into those with and without diabetes mellitus. Results: In this study, 588 (37%) patients were diabetic with a mean age of 59 years and included more female than male diabetics (43% versus 33%; p<0.001). Diabetic patients were more likely to present with unstable angina (55% versus 44%; p<0.001) and less likely to present with ST elevation myocardial infarction (20% versus 27%; p=0.001). Both groups received ACS treatment equally; however, diabetic patients were more likely to he treated with glycoprotein IIb/IIIa antagonists and angiotensin-converting enzyme inhibitors or receptor blockers. Diabetic patients experienced more recurrent ischemia (12% versus 8%; p=0.043), heart failure (29% versus 23%; p=0.009), cardiogenic shock (7.5% versus 4.6%; p=0.018), and ventilator requirement (7.3% versus 4.1%; p=0.006). When adjusted for age and gender, diabetes status was an independent risk factor of in-hospital mortality in ACS patients (adjusted odd ratio, 1.68; 95% confidence interval, 1.02-2.77; p=0.042). Conclusions: Diabetic ACS patients have different clinical characteristics and poorer outcomes. Present treatment strategies are not sufficient to counter the adverse impact of diabetes. More effective and evidence-based therapeutic strategies should he identified and used in diabetic ACS patients.