Comparison of Extent of Coronary Artery Disease in Angiography of Diabetics and Non-Diabetics

Background- Type 2 diabetes mellitus is associated with an increased prevalence of atherosclerosis and coronary heart disease. This study was performed to determine the severity and extent of coronary artery disease in diabetics compared to non-diabetics. Methods- Fifty type 2 diabetic patients and 50 sex-and age-matched non-diabetics, who were candidates for angiography to diagnose coronary artery disease, were enrolled in the study. Those patients with valvular heart disease, congenital heart disease and rhythm disturbances were excluded from the study. Selective angiography was performed, and a single experienced observer reported the angiograms and Gensini scores were calculated to determine the severity of the atherosclerosis. Results- Sixty males and 40 females were included in the study, with a mean age of 57.3 +/- 8.4 (Mean +/- SD). Diabetic patients had higher Gensini scores than non-diabetics (51.44 +/- 44.6 vs. 34.12 +/- 29.9, P<0.05). Categorical staging of various types of coronary artery disease significantly differed in diabetic and non-diabetics (P<0.05), and multi-vessel CAD (P<0.05) was seen more often in diabetics. Moreover, mono-vessel CAD (P<0.05) was more common in non-diabetics, but normal coronary arteries did not significantly differ between the two groups. Hyperlipidemia and diabetes were associated with Gensini scores independently (P=0.02 and P=0.04, respectively), and a trend toward a positive association was seen between family history of coronary artery disease and Gensini score (P=0.06), but hypertension and cigarette smoking did not show any significant association. Left main coronary artery disease, disease of the proximal portion of left anterior descending artery, presence of occluded vessels, ejection fraction, left ventricular end diastolic pressure, and catheter-based systolic and diastolic blood pressure were not significantly different between diabetics and non-diabetics. Conclusion- According to our study, diabetics may have more extensive coronary artery disease at presentation, hence care must be taken in the diagnosis and management of these patients, and it is better to maintain a lower threshold for performing noninvasive and sometimes invasive studies for the detection of coronary artery disease in diabetics.