Schmitz Timo, Wein Bastian, Raake Philip, Heier Margit, Peters Annette, Linseisen Jakob, Meisinger Christa
Epidemiology, Medical Faculty, University of Augsburg, Augsburg, Germany.
Department of Cardiology, Respiratory Medicine and Intensive Care, University Hospital Augsburg, Augsburg, Germany.
Front Cardiovasc Med. 2024 Jan 15;11:1324451. doi: 10.3389/fcvm.2024.1324451. eCollection 2024.
The objective of this study was to investigate the differences in presenting symptoms between patients with and without diabetes being diagnosed with an acute myocardial infarction (AMI).
A total of 5,900 patients with a first-time AMI were included into the analysis. All patients aged between 25 and 84 years were recorded by the population-based Myocardial Infarction Registry in Augsburg, Germany, between 2010 and 2017. The presence (yes/no) of 12 AMI typical symptoms during the acute event was assessed within the scope of a face-to-face interview. Multivariable adjusted logistic regression models were calculated to analyze the associations between presenting symptoms and diabetes mellitus in AMI patients.
Patients with diabetes had significantly less frequent typical pain symptoms, including typical chest pain. Also, other symptoms like sweating, vomiting/nausea, dizziness/vertigo and fear of death/feeling of annihilation occurred significantly more likely in non-diabetic patients. The only exception was the symptom of shortness of breath, which was found significantly more often in patients with diabetes. In multivariable-adjusted regression models, however, the observed effects were attenuated. In patients younger than 55 years, the associations between diabetes and various symptoms were mainly missing.
Type 2 diabetes mellitus is a risk factor not only for the development of AMI, but is also associated with an adverse outcome after AMI. Atypical clinical presentation additionally complicates the diagnostic process. It is therefore essential for physicians to be aware of the more often atypical symptoms that diabetic AMI patients report.
本研究的目的是调查已确诊为急性心肌梗死（AMI）的糖尿病患者与非糖尿病患者在症状表现上的差异。
总共5900例首次发生急性心肌梗死的患者纳入分析。2010年至2017年期间，德国奥格斯堡基于人群的心肌梗死登记处记录了所有年龄在25至84岁之间的患者。在面对面访谈范围内评估急性事件期间12种急性心肌梗死典型症状的存在情况（是/否）。计算多变量调整逻辑回归模型，以分析急性心肌梗死患者症状表现与糖尿病之间的关联。
糖尿病患者典型疼痛症状（包括典型胸痛）的发生频率显著较低。此外，出汗、呕吐/恶心、头晕/眩晕以及濒死感/毁灭感等其他症状在非糖尿病患者中出现的可能性显著更高。唯一的例外是呼吸急促症状，在糖尿病患者中出现的频率显著更高。然而，在多变量调整回归模型中，观察到的效应有所减弱。在55岁以下的患者中，糖尿病与各种症状之间的关联大多不存在。
2型糖尿病不仅是急性心肌梗死发生的危险因素，还与急性心肌梗死后的不良结局相关。非典型临床表现会使诊断过程更加复杂。因此，医生必须了解糖尿病急性心肌梗死患者更常出现的非典型症状。
