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Clinical parameters and its association with coronary involvement in diabetic vs. non-diabetic cad patients with reference to syntax score

Tejas Shah

Abstact:

Background: Cardiac involvement is one of the commonest causes of morbidity and mortality in patients with diabetes. It manifest as coronary artery disease. Definitive diagnosis, precise assessment of CAD requires invasive diagnostic modality like conventional coronary angiography and its anatomic severity can be judged by Syntax score.

Aims and objectives: 1) Extent and severity of coronary artery disease with reference to Syntax score between diabetics Vs Non diabetics. 2) Correlation between fasting glucose, Glycated Hemoglobin (Hb A1c),TC/HDL-C ratio, BMI (body mass index) and severity of coronary artery disease.

Materials and methodology: 200 patients (100 Diabetics and 100 Non diabetics) after meeting inclusion and exclusion criteria, admitted with symptoms of acute or chronic coronary syndrome, scheduled to undergo coronary angiogram were taken.

Results: In our study duration of diabetes and severity of coronary artery disease was not correlating but as compared to non-diabetics,diabetics had higher syntax score, 23-32 30(30%) were diabetics, while 13(13%)were nondiabetics, and score>33 9, (9%) diabetics as compared to nondiabetic has 1%,p value<0.001. Diabetics have more numbers of TVD (Triple Vessel Disease) 52% as compared to nondiabetics 12%, p value<0.001. Diabetics had more numbers of Total occlusion of vessel (p=0.027), Calcification (p=0.003), Proximal vessel involvement, (p=0.000), CTO (chronic total occlusion), p=0.027 and diffusely disease vessels (p=0.000), as compared to nondiabetics. Biochemical parameters like FBS, HbA1c and clinical parameters like BMI and Hypertension were not correlating with severity of coronary artery disease. In controls age is highly correlated with severity of coronary artery disease with correlation coefficient of 0.363 (p value=0.0001) whereas in cases TC/HDL is highly correlated with severity of coronary artery disease with correlation coefficient of 0.205 (p value 0.041).

Conclusion: Diabetics have more numbers of Total vessel occlusion, CTOs, Proximal vessel involvement, calcifications and diffuse CAD.TC/HDL is better parameter to predict severity of CAD.