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Comparitive angiographic profile in diabetic and non-diabetic patients with acute coronary syndrome
Srinidhi S Hegde1, P Mallesh2, S M Yeli3
1Senior Resident, Department of Medicine, MMC & RI , Mysore, India .
Insights
Diabetic patients with acute coronary syndrome (ACS) show significantly higher rates of multi-vessel coronary artery disease (CAD) and require more bypass surgeries. Early-onset ACS and severe CAD are more prevalent in diabetics, especially those with elevated HbA1c levels.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- Diabetes mellitus is a major risk factor for cardiovascular mortality, with coronary artery disease (CAD) being the most common manifestation.
- Accurate assessment of CAD severity in diabetic patients often necessitates invasive procedures like coronary angiography.
Purpose of the Study:
- To investigate the angiographic characteristics of coronary artery disease in patients experiencing acute coronary syndrome (ACS).
- To compare the extent, number, and severity of coronary artery involvement in diabetic versus non-diabetic patients with ACS.
Main Methods:
- A study group of 100 patients with ACS (50 diabetics, 50 non-diabetics) underwent coronary angiography.
- Blood glucose and HbA1c levels were assessed for all participants.
- Statistical analysis, including the Chi-square test, was employed to determine significant differences between the groups (p < 0.05).
Main Results:
- Diabetic patients exhibited a significantly higher incidence of triple or multi-vessel disease (44%) compared to non-diabetics (16%).
- Diabetics accounted for a larger proportion (61.3%) of the total vessels involved in ACS patients.
- A substantial percentage of diabetic patients (46%) required coronary artery bypass grafting (CABG), particularly those with HbA1c > 8.5%.
Conclusions:
- Diabetic patients with ACS present with earlier onset, more severe, and extensive coronary artery disease, including a higher prevalence of multi-vessel disease, compared to non-diabetics.
- Elevated HbA1c levels in diabetics are associated with greater coronary vessel involvement and an increased likelihood of requiring CABG.
- These findings underscore the critical impact of diabetes on the severity and management of coronary artery disease in ACS patients.
Background:
Cardiac adversity is by far the commonest cause of mortality in patients with diabetes. Cardiac involvement in diabetes commonly manifest as coronary artery disease (CAD). Definitive diagnosis,precise assessment and anatomic severity of CAD requires invasive diagnostic modality like coronary angiography.
Aims And Objectives:
To study angiographic extents, type of vessels, number of vessels, severity involving coronary artery and its branches in patients with acute coronary syndrome(ACS).Compare the same in diabetics and non diabetics with ACS.
Materials And Methods:
Hundred patients with ACS,50 diabetics and 50 nondiabetics admitted in Bapuji Hospital ICCU attached to J.J.M. Medical College were selected randomly during a period of approximately one and half years formed the study group. RBS, FBS was done in all 100 pateints, HbA1c in all diabetics. All subjects with ACS were taken up for coronary angiography.
Statistical Analysis:
Chi-square test was used to determine any significant difference between two groups. p-value of less than 0.05 was considered significant.
Results:
In our study 22 (44%) out of 50 diabetic patients had triple or multi-vessel disease compared to 8 (16%) out of 50 non diabetics. Hundred patients with ACS, number of vessels involved were 199, of which 61.3% in diabetics and 38.6% in non diabetics, 23(46%) of 50 diabetic patients required CABG as treatment outcome. HbA1c levels of >8.5%, 69.2% had triple / multi vessel disease and 19 (73.1%) of 23 patients who had to undergo CABG had HbA1c levels >8.5%, 24% of diabetics were in third decade, 40% were in fourth decade as compared to 10% and 26% of non-diabetics of similar age group.
Interpretation And Conclusion:
This study showed that ACS in diabetic patients presented much earlier in life, the severity and extent of CAD and incidence of triple/multi vessel disease was significantly high in diabetics when compared to nondiabetics with ACS. Diabetics with high HbA1c had more number of coronary vessel involvement and the mode of treatment required in them was CABG.
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