Epidemiological‐clinical and paraclinical particularities of acute coronary syndrome without persistent ST‐segment elevation in type 2 diabetes mellitus: Retrospective comparative study in a Malagasy population

INTRODUCTION: This study aimed at determining the epidemiological‐clinical and paraclinical particularities of non‐ST‐segment elevation acute coronary syndrome (NSTE‐ACS) in Malagasy with type 2 diabetes mellitus (T2DM). METHODS: This was a retrospective, descriptive and comparative study between patients with and without T2DM, carried out over a period of 38 months. The diagnosis of NSTE‐ACS was retained in front of the association of chest discomfort, electrical abnormalities and elevations beyond fivefold the upper reference limit of high‐sensitivity cardiac troponin. RESULT: With 130 patients included, the overall prevalence of NSTE‐ACS was 4.1%, of which 68 patients (52.3%) had T2DM. Compared to without T2DM, NSTE‐ACS in T2DM was characterized by young age (p = .0002), high‐frequency hypertension (OR 2.92 [1.23–7.25]; p = .0041), overweight/obesity (OR 4.39 [1.72–12.4]; p = .0002) and microalbuminuria (p < .0001), accelerated heart rate (p = .0104), atypical chest discomfort (OR 5.57 [2.21–15.7]; p < .0001), pulmonary crepitations (OR 2.25 [1.02–5.14]; p = .0224), high GRACE score (p = .0016), damage of extensive anterior leads (OR 2.11 [1.02–4.98]; p = .0402) and septal lead (OR 3.64 [1.41–10.3]; p = .0015), significant increase in cardiac troponin (p < .0001), high left ventricular filling pressure (OR 3.39 [1.51–7.90]; p = .001). CONCLUSION: NSTE‐ACS in T2DM is frequent, with an atypical clinical and severe paraclinical presentations. Adequate and multidisciplinary management of cardiovascular risk factors, including T2DM, could thus minimize the occurrence of NSTE‐ACS and improve this profile.