The worse hospital outcome of diabetic patients is not explained by the severity of underlying coronary artery disease.

Introduction: Diabetes mellitus has a high prevalence in developed countries and is associated with high cardiovascular morbidity and mortality rates. In this study we evaluated in-hospital evolution of diabetic patients admitted to a cardiac care unit with acute coronary syndrome without ST segment elevation. Methods: We analyzed a population of 176 consecutive patients, 36 (21 %) with diabetes, admitted with chest pain at rest, elevated biological markers for myocardial necrosis and/or ST segment/T wave changes suggestive of myocardial ischemia. Results: The groups were similar in terms of age, sex, presence of other risk factors for coronary artery disease (CAD), past history of CAD or myocardial revascularization. There were no differences between the groups with respect to extent of CAD, left ventricular function or blood levels of biological markers. The comparison between the two groups did not show any statistical difference concerning the following in hospital events: non-Q waveMI, Q-wave MI, PTCA and death. On the other hand, the diabetic patients had a worse outcome in term in term of congestive heart failure (25% and 10% , 11%, p=0.04), CAVG (25% and 10%, p=0.02) and combination of death, congestive heart failure and Q-wave MI (42% and 23%, p=0.02). Conclusion: In spite of similar extent of CAD and similar left ventricular function, diabetes mellitus in patients with acute coronary syndrome without ST segment elevation identifies a higher-risk population with more complicated in-hospital outcome.