Abstract 17876: Risk Factors and Thirty-day Adverse Events in Emergency Department Patients With Symptoms of Myocardial Ischemia With and Without Diabetes

Objective: To evaluate the association between diabetes and demographic and clinical characteristics and 30-day adverse cardiovascular events (return to the emergency department [ED] with signs and/or symptoms of acute myocardial ischemia, all-cause admission, acute myocardial infarction, use of reperfusion therapy, and all-cause mortality) in patients presenting to the ED with chest pain and/or symptoms suggestive of acute myocardial ischemia. Methods: We conducted a cross-sectional study of 163 adult patients presenting to the ED at a single hospital with symptoms of acute myocardial ischemia warranting evaluation with an electrocardiogram and a cardiac troponin test. We analyzed data collected 30±7 days after ED/hospital discharge from the index visit. Using chi-squared tests, we compared patients with a history of diabetes (n=65) to those without (n=98) on demographic and clinical characteristics and on 30-day adverse cardiovascular events. Findings: Patients with a history of diabetes were significantly more likely to be older (p<.001), overweight (p=.003), have a history of coronary artery disease (p<.001), heart failure (p=.016), and hyperlipidemia (p<.001) than patients without a history of diabetes. We found a significant association between a history of diabetes and a composite of 30-day adverse cardiovascular events (p=.036). We also found a significant association between a history of diabetes and admission to the hospital within 30 days of the index visit (p=.015). Conclusion: Study findings emphasize the predominance of more modifiable and non-modifiable cardiovascular risk factors in patients with diabetes compared to those without diabetes among patients presenting to the ED with signs and/or symptoms of acute myocardial ischemia. Past research has demonstrated a strong association of optimal weight, glycemic, and blood pressure management with protective benefits in patients with diabetes. Tailored educational interventions in the ED may reduce modifiable risks in these patients, their hospital return rate, and likelihood of 30-day adverse cardiovascular outcomes.