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Comparison of diabetic and non-diabetic patients referred for coronary angiography
B Lindvall1, B Brorsson, J Herlitz
1Department of Cardiology, Huddinge University Hospital, Sweden.
Insights
Diabetic patients referred for coronary angiography often present with more severe symptoms and advanced coronary artery disease. This study suggests coronary angiography might be underutilized in diabetic individuals experiencing chest pain, highlighting a potential gap in care.
Area of Science:
- Cardiology
- Diabetology
- Public Health
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease.
- Understanding differences in presentation and outcomes for diabetic patients undergoing coronary angiography is crucial for optimizing cardiovascular care.
Purpose of the Study:
- To compare diabetic and non-diabetic patients referred for coronary angiography.
- To identify differences in clinical characteristics, angiographic findings, medication use, and mortality between these groups.
Main Methods:
- Prospective data collection from seven Swedish heart centers in 1994.
- Inclusion of 2762 patients referred for coronary revascularization.
- Comparison of outcomes between 406 diabetic patients and 2356 non-diabetic patients.
Main Results:
- Diabetic patients (15% of cohort) reported more severe angina (CCS III-IV) and higher rates of arterial hypertension.
- Diabetic patients showed a greater prevalence of depressed myocardial function (EF<35%) and extensive coronary artery disease (left main/3-VD).
- Mortality over 21 months was significantly higher in diabetic patients (7.9%) compared to non-diabetic patients (3.6%).
Conclusions:
- Diabetic patients referred for coronary angiography exhibit more severe symptoms and advanced coronary artery disease.
- The findings suggest a potential underuse of coronary angiography in diabetic patients presenting with chest pain.
- This highlights a need to reassess diagnostic strategies for cardiovascular disease in diabetic populations.
Aim:
To evaluate whether diabetic patients differ from non-diabetic patients when referred for coronary angiography regarding previous history, indication for and findings at coronary angiography, use of medication, exercise test results and mortality.
Methods:
Data were prospectively collected on patients referred for consideration of coronary revascularization to seven of the eight public Swedish heart centers that performed approximately 92% of all bypass operations in Sweden in 1994.
Results:
2762 patients were included of whom 406 (15%) had a history of diabetes mellitus. There was no difference in age or sex in the two groups. Chronic stable angina was the most common indication (73% in both groups) and only 3% were admitted due to silent ischemia. Diabetic patients had more severe symptoms (Canadian Cardiovascular Society III-IV) than non-diabetic patients (66% vs. 58%, p<0.01). They more frequently used ACE-inhibitors (33% vs. 19%, p<0.0001) and calcium channel blockers (47% vs. 40%, p<0.01) and more often had a diagnosis of arterial hypertension than non-diabetic patients (50% vs. 33%, p<0.0001). Diabetic patients more often had depressed myocardial function (EF<35%); 12% and 8%, respectively (p<0.01), and more extensive coronary artery disease (left main/3-VD; 48% vs. 37%, p<0.001). The mortality during the subsequent 21 months was 7.9% among diabetic patients and 3.6% among non-diabetic patients (p<0.001).
Conclusion:
Among patients being referred for coronary angiography in Sweden, 15% were patients with a history of diabetes. They differed from patients without such a history by more often having severe symptoms and a higher prevalence of left main/triple vessel disease. Coronary angiography may thus be underused in diabetic patients with chest pain.