What is the clinical evidence from this study?

Study design: Case-Control. Population: Coronary artery disease (n=116). Intervention: Diabetes vs. Non-diabetic controls. Primary outcome: Diseased coronary vessels (p=<0.005).

January 1, 1978

Diffuse coronary artery disease in diabetic patients: fact or fiction?

Q: What are the key findings of this study?

Diabetes was associated with a higher proportion of diseased coronary vessels compared to matched controls (68% vs 46%, P<0.005), but no increase in diffuse or inoperable disease.

Key Result

Diabetes was associated with a higher proportion of diseased coronary vessels compared to matched controls (68% vs 46%, P<0.005), but no increase in diffuse or inoperable disease.

Study Design

Type

Case-Control (n=116)

Structured PICO

Does diabetes mellitus increase the severity, diffuseness, or inoperability of coronary artery disease in patients undergoing cardiac catheterization?

Population

116 patients (37 diabetic and 79 matched controls) undergoing cardiac catheterization, evaluated retrospectively for coronary artery disease severity.

Exposure

Diabetes mellitus (exposure)

Comparator

Non-diabetic controls matched for sex, age, hypertension, hyperlipidemia, and smoking

Outcome

Severity and extent of coronary artery disease assessed using an angiographic grading system (including total coronary score, number of diseased vessels, diffuse disease, and inoperability)surrogate

Diabetic patients undergoing cardiac catheterization have a greater overall burden of coronary artery disease compared to matched non-diabetics, but the disease is not significantly more diffuse or inoperable.

Main Result

Absolute Event Rate: 68% vs 46%

p-value: p=<0.005

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.