Impact of Type II Diabetes on the Presentation of Coronary Artery Disease and Outcomes of Percutaneous Coronary Intervention in Female Patients
Authors: Yalampati Rama , Beatrice Anne 
Published: August 2018

Background Coronary artery disease (CAD) is a well-established complication of type II diabetes mellitus affecting both men and women worldwide. A vast amount of research has shown evidence of increased risk for CAD in patients with type II diabetes compared with the general population and that this increased relative risk is more prevalent in women. The primary aim of this study is to observe the impact of type II diabetes on the severity of CAD at the time of presentation and also on the outcomes of CAD after PCI (percutaneous coronary intervention) in female patients.

Methods A prospective single-center study for the period of 1 year, including 267 female CAD patients who underwent PCI was conducted. The patient population was divided into two major groups of which 171 (64%) patients had type II diabetes (group A) and 96 (36%) patients were nondiabetic (group B). The clinical presentations of CAD in type II diabetics and nondiabetics were compared in the form of chronic stable angina (CSA), acute coronary syndrome (ACS), left ventricular (LV) dysfunction, renal dysfunction, and the number of vessels involved. Primary outcomes were compared in the form of major adverse cardiovascular events (MACE), whereas secondary outcomes were compared in the form of statin-induced myopathy, also referred to as contrast-induced nephropathy (CIN).

Results At presentation, 60 (35.08%) of 171 female patients with type II diabetes (group A) had CSA and 121 (70.76%) had ACS. Baseline creatinine was determined to be 1.17 ± 1.02 mg/dL amongst the participants. Moreover, 51 (29.8%) patients were observed to have LV dysfunction. The total number of lesions treated in this group was 237. Among group B, that is, 96 nondiabetic female patients, 62 (64.5%) patients had CSA, 34 (35.4%) had ACS, 39 (40.6%) had LV dysfunction, the baseline creatinine was (0.95 ± 0.39) mg/dL. The total number of lesions treated was in this group was 130.

The difference in incidence of CSA, ACS, and renal dysfunction was statistically significant with p = 0.000, 0.000, and 0.016, respectively. The incidence of CSA was greater in group B, that is, nondiabetics; whereas, the incidence of ACS and renal dysfunction was found to be greater in group A, that is, type II diabetics. Moreover, the number of vascular territories involved was found to be more in patients with type II diabetes. Although, the incidence of severe LV dysfunction was greater in patients with type II diabetes, the difference was not statistically significant.

When considering 1 year outcomes in female patients with type II diabetes, three cases of deaths, one case of acute stent occlusion, one subacute stent occlusion, one periprocedural myocardial infarction (MI), one CSA, one statin-induce myopathy, and one rhabdomyolysis are reported. Whereas, in nondiabetic female patients, one case of death, one CSA, one CIN, one chronic thrombus right radial artery, and one pseudoaneurysm and rupture are reported.

Conclusion The results from this study suggest that in female patients with CAD, ACS presentation is more common in type II diabetes; whereas, CSA presentation is more common in nondiabetics. Moreover, multi-vessel involvement is more common in type II diabetes. Following PCI, there has been an increase in the prevalence of MACE, statin-induced myopathy and rhabdomyolysis in patients with type II diabetes. In conclusion, type II diabetes has been reported to significantly influence the severity of presentation, number of lesions involved, and complications following PCI.