Table 3.

Studies which have not shown that diabetes mellitus is a predictor of atypical presentation of acute coronary syndrome

Ref.	Study population/	Study type/country	Atypical presentation %	Conclusion
Meshack et al[77]	589 patients, aged 25 to 74 yr, with AMI	A community-based surveillance program/ United States	Sweating (64.2%), fatigue (62.6%), dyspnea (60.3%), and arm or jaw pain (58.2%).	Adjusting for age, DM, gender, and relative to non-Hispanic whites, Mexican Americans were more likely to report chest pain, upper back pain, and palpitations, and less likely to report arm or jaw pain
Richman et al[78]	216 (19 women with DM); AMI	A prospective, observational study/United States	No statistical difference in diabetics vs non-diabetics in terms of the presence chest pain	No difference in the frequency of chest pain or associated symptoms by diabetic status (P ≥ 0.05) -no chest pain symptoms was more common in diabetic patients (NS)
Kentsch et al[79]	1042 (330 women; 155 women with DM) with STEMI	Secondary analysis of MITRA PLUS (18786 pts.; North German Registry, NGR, 1042 pts.)/ Germany	16.9% of DM and 15.0% of non-DM	No difference in the frequency or intensity of chest pain by diabetic status Patients with DM reported significantly more dyspnea than those without DM (29.5% vs 19.5%; P < 0.01)
DeVon et al[80]	100 (50 women, 23 women with DM); DM	rospective secondary analysis; descriptive, cross-sectional; structured interview/United States	3%	No difference in the frequency and severity of chest pain in diabetics vs non-diabetics (P ≥ 0.05) No differences in UA symptoms by diabetic status Patients with DM reported weakness as the second most common symptom and more likely to describe chest pain as squeezing (P = 0.02) or aching (P = 0.04) than non-diabetics Diabetics had ↑ frequency of hyperventilation (P = 0.04) and afrequency of nausea (P = 0.04) than non-diabetics
Thuresson et al[81]	N = 1939 (480 women, 82 women with DM)	Descriptive, cross-sectional study/Sweden	See conclusion	No difference in chest pain or other ACS symptoms by DM status Women reported more tiredness/weakness, anxiety/fear, vomiting, back pain, left arm pain and neck or jaw pain than men (P = 0.01).

^aDecreased/lower. STEMI: ST elevation myocardial infarction; UA: Unstable angina AMI: Acute myocardial infarction; ACS: Acute coronary syndrome; DM: Diabetes mellitus; PVD: Peripheral vascular disease.