A comparative study of clinical features and angiographic profile in diabetics and non diabetics

Abstract

Background: Diabetes mellitus is a major risk factor for coronary artery disease (CAD) and is associated with accelerated atherosclerosis, leading to significant cardiovascular morbidity and mortality. The present study aimed to compare the clinical features and angiographic profiles of CAD between diabetic and non-diabetic patients. Methods: This cross-sectional comparative study included 126 patients (63 diabetics and 63 non-diabetics) who underwent coronary angiography. Demographic characteristics, clinical presentations, electrocardiographic findings, echocardiographic parameters, including ejection fraction and regional wall motion abnormalities, and detailed angiographic profiles were analysed and compared between the two groups. Results: The majority of patients in both groups were in the 51-60 years age range with male preponderance. Chest pain was the predominant symptom in both groups, but diabetic patients showed a significantly higher prevalence of giddiness (p=0.02) and other atypical symptoms (p=0.04). Glycemic control assessment revealed that 49.2% of diabetic patients had HbA1c levels between 8.6-11%, with a significant association between higher HbA1c levels and CAD severity (p=0.009). Left ventricular dysfunction was more pronounced in diabetics, with a higher prevalence of reduced ejection fraction (p=0.03) and regional wall motion abnormalities (p=0.05). Angiographic findings demonstrated that diabetic patients had a significantly higher prevalence of triple-vessel disease (42.9% vs 23.8%) and double-vessel disease (27% vs 15.9%) compared to non-diabetics (p<0.001). The left circumflex (63.5% vs 34.9%, p=0.001) and right coronary arteries (55.6% vs 36.5%, p=0.03) were more frequently involved in diabetics, suggesting a predilection for multi-vessel and diffuse CAD. Conclusion: Diabetic patients with CAD exhibit more atypical clinical presentations, more pronounced left ventricular dysfunction, and significantly more extensive, diffuse, and complex coronary artery involvement compared to non-diabetics. Poor glycemic control correlates with increased CAD severity. These findings emphasize the importance of early screening, aggressive risk factor modification, and appropriate revascularization strategies in diabetic patients with CAD.