Coronary Angiography Findings among Diabetics and Non Diabetics Presenting with Acute Coronary Syndrome: A Case-control Study

Introduction: Patients with type-2 diabetes are at high risk for many Cardiovascular Diseases (CVD) such as coronary artery disease, stroke, peripheral arterial disease, cardiomyopathy, and congestive heart failure.

Aim: To evaluate the coronary angiography profile in diabetics and non diabetics presenting with Acute Coronary Syndrome (ACS) in a tertiary care hospital in eastern India.

Materials and Methods: This case-control study conducted from September 2018 to October 2019 at Nil Ratan Sircar Medical College, Kolkata,West Bengal, India, comprised 200 patients (100 were diabetics and 100 were non diabetics) diagnosed with ACS based on Electrocardiography (ECG) and cardiac enzymes. Data about baseline demographic, clinical and angiographic characteristics were collected. Moreover, angiographic thrombus burden grade, Cohen and Rentrop grade for collateral circulation, and Synergy Between Percutaneous Coronary intervention with Taxus and Cardiac Surgery (SYNTAX) score were also reported.

Results: The mean number of vessel involvement was significantly higher in diabetics as opposed to non diabetics (2.1% vs. 1.5%, p-value=0.001). Left main coronary artery disease (20% vs. 10%, p-value=0.0012), ostio-proximal disease (36% vs. 20%; p-value=0.032), bi/trifurcation lesion (40% vs. 22%; p-value=0.032), diffuse disease (60% vs. 30%; p-value=0.012), chronic total occlusion (16% vs. 7%; p-value=0.008), coronary calcification (22% vs. 12%; p-value=0.04), and microvascular disease (10% vs. 4%; p-value=0.02) were significantly more frequent in diabetics compared to non diabetics. Even after thrombolysis, thrombus grade 4-5 was highly observed in diabetics than non diabetics (4% vs. 0%; p-value=0.001). Grade 3 collateral circulation was less frequently developed in diabetics than non diabetics (1% vs. 4%; p-value=0.001). High SYNTAX score was highly noticed among diabetics than non diabetics (36% vs 20%; p-value=0.03).

Conclusion: Diabetics with ACS had more thrombus burden of higher grade along with lesser collaterals, and higher SYNTAX score.