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Diffuse coronary artery disease in diabetic patients: fact or fiction?
Insights
Diabetic patients with chest pain exhibit more severe coronary artery disease than non-diabetics. However, the extent of diffuse or inoperable disease was similar between groups.
Area of Science:
- Cardiology
- Diabetology
- Vascular Medicine
Background:
- Diabetes mellitus is a significant risk factor for cardiovascular disease.
- Diabetic patients often present with more advanced coronary artery disease (CAD).
Purpose of the Study:
- To compare the severity and extent of angiographically determined coronary artery disease in diabetic patients versus non-diabetic controls.
- To investigate differences in diffuse and inoperable coronary artery disease between the two groups.
Main Methods:
- Retrospective review of 1,653 patients undergoing cardiac catheterization.
- Matched cohort analysis of 37 diabetic patients and 79 control patients based on sex, age, and cardiovascular risk factors.
- Assessment of coronary artery disease severity using an established angiographic grading system and total coronary score.
Main Results:
- Diabetic patients showed a higher prevalence of three-vessel disease (43% vs. 25%).
- A greater proportion of diseased coronary vessels was observed in diabetics (68% vs. 46%, P < 0.005).
- Diabetic patients had a higher total coronary score (mean 10.0 vs. 7.5, P < 0.01), indicating more extensive disease.
Conclusions:
- Diabetic patients with chest pain demonstrate significantly more coronary artery disease compared to non-diabetic individuals.
- The study found no statistically significant difference in the proportion of diffuse or inoperable coronary artery disease between diabetic and non-diabetic patients.
- These findings highlight the increased burden of CAD in diabetes but suggest similar patterns of disease complexity.
Abstract:
To compare angiographically-determined coronary artery disease in diabetic patients with controls, 1,653 patients coming to cardiac catheterization were reviewed retrospectively to find 37 diabetic and 79 control patients matched for sex, age (+/- 3 years), and risk factors (hypertension, hyperlipidemia, and smoking). The severity of coronary artery disease was assessed using an angiographic grading system. The following results were obtained: 16 of 37 diabetic patients (43%) had three-vessel disease compared to 20 of 79 controls (25%). Seventy-six of 111 (68%) diabetic vessels were diseased compared to 110 of 237 control vessels (46%) (P less than 0.005). The total coronary score reflecting total extent of disease for diabetic patients was 371 (mean 10.0 +/- (SEM) compared to 594 for controls (mean 7.5 +/- 0.7, (P less than 0.01). Diabetic patients had a statistically similar number of diffusely diseased vessels as controls (28% vs 22%). There were only three of 76 diabetic vessels (4%) considered inoperable compared to seven of 110 (6%) control vessels. We conclude that diabetic patients with chest pain have more coronary artery disease than nondiabetics, but no more diffuse or inoperable disease.