The Extent of Coronary Artery Disease in Diabetic Patients with Myocardial Infarction: an ECG Study

1986 ◽  
Vol 3 (6) ◽  
pp. 541-544 ◽  
Author(s):  
G. A. Oswald ◽  
J. S. Corcoran ◽  
D. L. H. Patterson ◽  
J. S. Yudkin
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Artery Disease

scholarly journals Effects of Preoperative HbA1c Levels on the Postoperative Outcomes of Coronary Artery Disease Surgical Treatment in Patients with Diabetes Mellitus and Nondiabetic Patients: A Systematic Review and Meta-Analysis

2020 ◽  
Vol 2020 ◽  
pp. 1-14
Author(s):  
Jinjing Wang ◽  
Xufei Luo ◽  
Xinye Jin ◽  
Meng Lv ◽  
Xueqiong Li ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Renal Failure ◽  
Coronary Artery ◽  
Surgical Treatment ◽  
Meta Analysis ◽  
Postoperative Outcomes ◽  
Diabetic Patients ◽  
Artery Disease ◽  
Hba1c Levels

Aims. To investigate the effect of preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgery in diabetic and nondiabetic patients. Methods and Results. The MEDLINE (via PubMed), Cochrane Library, Web of Science, Embase, Wanfang Data, China National Knowledge Infrastructure (CNKI), and Chinese Biology Medicine (CBM) databases were used to search the effects of different preoperative HbA1c levels on the postoperative outcomes of coronary artery disease surgical treatment in diabetic and nondiabetic patients from inception to December 2018. Two review authors worked in an independent and duplicate manner to select eligible studies, extract data, and assess the risk of bias of the included studies. We used a meta-analysis to synthesize data and analyze subgroups, sensitivity, and publication bias as well as the GRADE methodology if appropriate. The literature search retrieved 886 records initially, and 23 cohort studies were included in the meta-analysis. In this meta-analysis, we found that there was a reduced incidence of surgical site infections (OR=2.94, 95% CI 2.18-3.98), renal failure events (OR=1.63, 95% CI 1.13-2.33), and myocardial infarction events (OR=1.69, 95% CI 1.16-2.47), as well as a shortened hospital stay (MD=1.08, 95% CI 0.46-1.71), in diabetic patients after coronary artery disease surgical treatment with lower preoperative HbA1c levels. For nondiabetic patients, a higher preoperative HbA1c level resulted in an increase in the incidence of mortality (OR=2.23, 95% CI 1.01-4.90) and renal failure (OR=2.33, 95% CI 1.32-4.12). No significant difference was found between higher and lower preoperative HbA1c levels in the incidence of mortality (OR=1.06, 95% CI 0.88-1.26), stroke (OR=1.49, 95% CI 0.94-2.37), or atrial fibrillation (OR=0.94, 95% CI 0.67-1.33); the length of ICU stay (MD=0.20, 95% CI -0.14-0.55); or sepsis incidence (OR=2.49, 95% CI 0.99-6.25) for diabetic patients or for myocardial infarction events (OR=1.32, 95% CI 0.27-6.31) or atrial fibrillation events (OR=0.99, 95% CI 0.74-1.33) for nondiabetic patients. The certainty of evidence was judged to be moderate or low. Conclusion. This meta-analysis showed that higher preoperative HbA1c levels may potentially increase the risk of surgical site infections, renal failure, and myocardial infarction and reduce the length of hospital stay in diabetic subjects after coronary artery disease surgical treatment and increase the risk of mortality and renal failure in nondiabetic patients. However, there was great inconsistency in defining higher preoperative HbA1c levels in the studies included; we still need high-quality RCTs with a sufficiently large sample size to further investigate this issue in the future. This trial is registered with CRD42019121531.

scholarly journals Comparative Study between Diabetic and non- Diabetic Patients Regarding Prevalence of Coronary Artery Disease and Plaque Composition by Multi-detector CT Coronary Angiography

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
H A Morsy ◽  
L A Habib ◽  
E H Abdeldayem ◽  
A I Sayed
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Heart Disease ◽  
Heart Disease ◽  
Coronary Artery ◽  
Diabetic Group ◽  
Diabetic Patients ◽  
Increased Risk ◽  
Artery Disease ◽  
Msct Angiography

Abstract Diabetes is known to be a major cardiovascular risk factor associated with significantly increased morbidity and mortality and particularly increased risk of major cardiac events especially myocardial infarction as a manifestation of highly incident coronary artery disease (CAD).This can lead to decreased life expectation and life quality. Major cause for myocardial infarction is plaque rupture. Prevalence of obstructive and non-obstructive plaques is increased in diabetic patients. Background and Objectives The prevalence of coronary heart disease in diabetic patients compared to non- diabetics and evaluating the composition of the plaque in diseased individuals in both groups by usage of multislice computed tomography (MSCT) angiography . Subjects and Methods A total of 80 consecutive MSCT angiography examinations were performed between August 2017 and June 2018. Of these, the patients were evaluated for the presence and type of atherosclerotic plaque and severity of luminal narrowing. Results Eighty (40 in the diabetic group and 40 in the non-diabetic group) patients underwent MSCT angiography with DM prevalence of 0.212 (95% Cl for AOR 0.056 -1.896). Among them, 20 patients (50 %) in the diabetic group and 14 patients (35 %) in the non-diabetic group had +ve coronary heart disease, 33.3 % had significant and moderately significant coronary narrowing on diabetic group and 31.3 % in non-diabetic group on MSCT angiography. Diabetic patients had more soft plaque compared with non-diabetic patients. Conclusion DM is not an independent factor for the disease occurrence in coronary artery disease but is a dependent factor in the association of other risk factors such as smoking ,hypertension and dyslipidemia.

scholarly journals Coronary Artery Bypass Grafting or Fractional Flow Reserve–Guided Percutaneous Coronary Intervention in Diabetic Patients With Multivessel Disease

2020 ◽  
Vol 13 (10) ◽  
Author(s):  
Giuseppe Di Gioia ◽  
Nina Soto Flores ◽  
Danilo Franco ◽  
Iginio Colaiori ◽  
Jeroen Sonck ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Hazard Ratio ◽  
Diabetic Patients ◽  
Multivessel Coronary Artery Disease ◽  
Fractional Flow ◽  
Flow Reserve ◽  
Cerebrovascular Events ◽  
Artery Disease

Background: In diabetic patients with multivessel coronary artery disease, coronary artery bypass grafting (CABG) has shown long-term benefits over percutaneous coronary intervention (PCI). Physiology-guided PCI has shown to improve clinical outcomes in multivessel coronary artery disease, though its impact in diabetic patients has never been investigated. We evaluated long-term clinical outcomes of diabetic patients with multivessel coronary artery disease treated with fractional flow reserve (FFR)–guided PCI compared with CABG. Methods: From 2010 to 2018, 4622 diabetic patients undergoing coronary angiography were screened for inclusion. The inclusion criterion was the presence of at least 2-vessel disease defined as with diameter stenosis ≥50%, in which at least 1 intermediate stenosis (diameter stenosis, 30%–70%) was treated or deferred according to FFR. Inverse probability of treatment weighting analysis was used to account for baseline differences with a contemporary cohort of patients treated with CABG. The primary end point was major adverse cardiovascular and cerebrovascular events, defined as all-cause death, myocardial infarction, revascularization, or stroke. Results: A total of 418 patients were included in the analysis. Among them, 209 patients underwent CABG and 209 FFR-guided PCI. At 5 years, the incidence of major adverse cardiovascular and cerebrovascular events was higher in the FFR-guided PCI versus the CABG group (44.5% versus 31.9%; hazard ratio, 1.60 [95% CI, 1.15–2.22]; P =0.005). No difference was found in the composite of all-cause death, myocardial infarction, or stroke (28.8% versus 27.5%; hazard ratio, 1.05 [95% CI, 0.72–1.53]; P =0.81). Repeat revascularization was more frequent with FFR-guided PCI (24.9% versus 8.2%; hazard ratio, 3.51 [95% CI, 1.93–6.40]; P <0.001). Conclusions: In diabetic patients with multivessel coronary artery disease, CABG was associated with a lower rate of major adverse cardiovascular and cerebrovascular events compared with FFR-guided PCI, driven by a higher rate of repeat revascularization. At 5-year follow-up, no difference was observed in the composite of all-cause death, myocardial infarction, or stroke between CABG and FFR-guided PCI. Graphic Abstract: A graphic abstract is available for this article.

Comparison of Extent and Severity of Coronary Artery Disease in Patients with and without Diabetes Mellitus Presenting with Non ST-Segment Elevation Myocardial Infarction

2020 ◽  
Vol 17 (2) ◽  
pp. 7-11
Author(s):  
Birat Krishna Timalsena ◽  
Rabi Malla ◽  
Arun Maskey ◽  
Sujeeb Rajbhandari ◽  
Aryan Parajuli ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
St Segment Elevation ◽  
Segment Elevation Myocardial Infarction ◽  
St Segment ◽  
Increased Risk ◽  
Artery Disease

Background and Aims: Diabetic patients are at increased risk of developing coronary artery disease. This study was conducted with the aim to compare the extent and severity of coronary artery disease in patients with and without diabetes presenting with non ST segment elevation myocardial infarction (NSTEMI). Methods: This was a single center, hospital based, cross sectional, observational comparative study in which total 172 patients presenting with NSTEMI were divided into two groups of 86 patients each based on presence or absence of diabetes mellitus. Demographic, laboratory and angiographic data were analysed and compared between two groups. Results: Among 86 patients enrolled in each group demographic characteristics and risk profile were not significantly different except for smoking status. Significant number of non-diabetics were current smoker (26.7% vs. 9.3%; p < 0.01). Hypertension was the most common risk factor in both groups. Non-diabetic patients had significantly high single vessel disease when compared to diabetics (11.6% vs 24.4%; p=0.03) while multivessel disease was significantly higher among diabetics (80.2% vs 59.3%; p<0.01). Diabetics had severe coronary artery disease with significantly high Gensini score (71.18±39.03 vs 59.84±33.68; p=0.04). There was no difference in terms of type of vessel affected. Conclusions: Diabetic patients presenting with NSTEMI are likely to have more severe and extensive coronary artery disease compared to non-diabetic patients.

scholarly journals Impact of Admission Glycated Hemoglobin on Angiographic Characteristics and Short Term Clinical Outcomes of Non-diabetic patients with Acute ST Elevation Myocardial Infarction

QJM ◽  
2020 ◽  
Vol 113 (Supplement_1) ◽  
Author(s):  
A A I Elabd ◽  
H G M Helmi ◽  
E M A Alfiky ◽  
R A Y Bassily
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Cardiac Events ◽  
Adverse Cardiac Events ◽  
Significant Difference ◽  
Study Population ◽  
St Elevation ◽  
Artery Disease

Abstract Background Coronary artery disease is the most important cause of death in industrialized countries. Diabetes mellitus is one of the most important modifiable risk factors of coronary artery disease. It increases the risk of coronary artery disease by 2 to 4-fold. Interestingly, this increased risk is not confined to patients with DM, but non-diabetic patients with impaired glucose tolerance (IGT) also may have an increased incidence of cardiovascular complications. Moreover, increased admission glucose levels may be related to a higher mortality rates in patients with acute myocardial infarction (AMI), regardless of diabetic status. Objective To assess the prognostic impact of admission HbA1c in patients without known diabetes mellitus who were admitted with acute ST elevation myocardial infarction, on outcome of 1ry PCI and short-term outcome of adverse cardiac events. Material and Methods This is an observational, this study was conducted at Coronary care unit & coronary catheterization lab unit of cardiology department in Ain Shams University & specialized hospitals. The study period was 6 months (From 1-9-2018 till 1-3-2019). Results 100 patients without prior diagnosis of DM were included in our study population Three categories of patients were created according to HbA1c level: Group 1 (&lt; 5.7%): 46 patients (46%); Group 2 (5.5 to 6.4%): 38patients (38%); Group 3 (&gt;6.5%): 16 patients (16%). Baseline characteristics of the study population are shown in Table 1. The mean age of our sample was 55.06 ± 11.73 years and 96% were males. There was highly statistically significant difference found between DM groups regarding SYNTAX score with P-value (0.002) & another highly significant difference in EF between the 3 groups. Conclusion The present study showed that admission higher HbA1c level in non-diabetic patients presented by acute STEMI is associated with more severe CAD, lower rate of complete revascularization TIMI 3, and higher incidence of adverse cardiac events and mortality. Introducing measurement of HbA1c in the CCU seems to be a simple method to obtain important information on mortality risk.

Association of Haemoglobin A1c Level with the Severity of Coronary Artery Disease in Non-diabetic Patients with Non-STSegment Elevation Myocardial Infarction

2021 ◽  
Vol 35 (2) ◽  
pp. 134-139
Author(s):  
Md Mamunuzzaman ◽  
Mahboob Ali ◽  
Mir Jamal Uddin ◽  
Shaila Nabi ◽  
Kajal Kumar Karmoker ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Gensini Score ◽  
Group I ◽  
St Elevation ◽  
Group Ii ◽  
Artery Disease ◽  
Vessel Score

Background: In nondiabetic patients with non-STsegment– elevation myocardial infarction, hyperglycemia may be associated with adverse outcome. Objective: To find out the association between HbA1c levels and the severity of coronary artery disease in non-diabetic patients with non-ST-segment elevation myocardial infarction Methods: This cross sectional analytical study was carried out at the National Institute of Cardiovascular Diseases (NICVD), Dhaka, during the period from July, 2012 to May, 2013. This study was done with an aim to find out the association between the HbA1c level and the angiographic severity of coronary artery disease in patients with non-ST- elevation myocardial infarction without diabetes mellitus. A total of 170 patients with NSTEMI without diabetes mellitus who agreed to undergo coronary angiography were included in the study. Eighty five patients were selected having HbA1c <5.7% (Group I) and 85 patients were selected having HbA1c ranging from 5.7% to 6.4% (Group II). Severity of the Coronary Artery Disease (CAD) was assessed by angiographic vessel score, and Gensini score. Results: The mean age of the studied patients was 51.0±9.0 years ranging from 30 to 80 years and male to female ratio was 4.5:1. The incidence of hypertension and level of RBS were significantly higher in group II than group I. The HbA1c level increased in accordance with the vessel score increment. There was a significant difference of the mean value of HbA1c among the vessel involvement groups. In this study mild CAD (scored”36) was significantly higher in group I and moderate to severe CAD (score>36) was significantly higher in group II according to Gensini score. This study showed a positive correlation between HbA1c and vessel score (r=0.47, p=0.01) and also between HbA1c and Gensini score (r=0.41, p=0.01). Conclusion: Elevated HbA1c levels in non-diabetic non- ST- elevation myocardial infarction patients are associated with the severity of coronary artery disease. Bangladesh Heart Journal 2020; 35(2) : 134-139

Poor outcome of diabetic patients with coronary artery disease and coexisting heart failure

2008 ◽  
Vol 7 ◽  
pp. 19-19
Author(s):  
B PONIKOWSKA ◽  
E JANKOWSKA ◽  
K WEGRZYNOWSKATEODORCZYK ◽  
S POWIERZA ◽  
L BORODULINNADZIEJA ◽  
...  
Keyword(s):  
Heart Failure ◽  
Coronary Artery Disease ◽  
Coronary Artery ◽  
Diabetic Patients ◽  
Poor Outcome ◽  
Artery Disease
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