Comparative Analysis of Coronary Angiographic Patterns in Patients with and Without Diabetes: An Observational Hospital-Based Investigation

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Roonak Hamid Wani , Abhishek Gupta , Mustafa Bashir

Department of Cardiovascular Technology, University School of Allied Health Sciences, Rayat Bahra University, Mohali, Punjab, India

Corresponding Author Email: ronaqwani000@gmail.com

DOI : https://doi.org/10.51470/AMSR.2026.05.01.06

Abstract

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Introduction

Diabetes mellitus (DM), particularly type 2, is a major risk factor for coronary artery disease (CAD) and is often considered equivalent to established CAD in terms of cardiovascular risk [1,2]. Globally, diabetes prevalence continues to rise, with significant contributions from India [3-5]. CAD remains a leading cause of mortality, and diabetes accelerates its progression through endothelial dysfunction, chronic hyperglycemia, advanced glycation end products (AGEs), oxidative stress, and activation of pathways such as diacylglycerol–protein kinase C [6-14].

Endothelial dysfunction in DM impairs vasodilation due to reduced nitric oxide availability, promotes oxidative stress, and enhances plaque formation and vulnerability [11-21]. Diabetic patients develop more aggressive atherosclerosis, with higher rates of multi-vessel involvement, diffuse lesions, and poorer outcomes post-acute coronary events [22-28]. Despite overall declines in CAD mortality, improvements are less pronounced in diabetic populations [29].

Coronary angiography is the gold standard for assessing CAD severity and pattern [30]. Multiple studies have shown that diabetic patients exhibit more extensive disease, including higher prevalence of triple-vessel disease, severe stenosis, and diffuse involvement compared to non-diabetics [31-37].

This study aimed to compare coronary angiographic findings between diabetic and non-diabetic patients, focusing on vessel involvement, stenosis severity, and post-procedure adverse effects.

Materials and Methods

This observational study was conducted in the Department of Cardiology, North End Hospital, Tapper, Baramulla, following institutional ethics committee approval.

Study Population: Sixty consecutive patients aged 35–70 years undergoing CAG for suspected CAD were included. Group A: Diabetic patients (n=30, confirmed diagnosis or ongoing treatment); Group B: Non-diabetic patients (n=30, normal fasting glucose, HbA1c, and history).

Inclusion Criteria: Age 35–70 years, BMI <30 kg/m², SpO₂ >90% on room air, normal serum creatinine and potassium.

Exclusion Criteria: Age >70 years, BMI >30 kg/m², pregnancy, ejection fraction <35%, chronic kidney disease, deranged creatinine, permanent pacemaker, septal defect, significant coronary dissection.

Procedure: Detailed clinical history, baseline investigations (fasting blood sugar, HbA1c, lipid profile, ECG, echocardiography), and informed consent were obtained. CAG was performed via femoral or radial access using the Judkins technique under local anaesthesia, with images acquired in standard projections.

Assessment Parameters:

• Demographics: Age, gender, height, weight, BMI.

• Angiographic: Number of vessels involved (normal/SVD/DVD/TVD), specific vessels (LAD, LCX, RCA, LMCA), stenosis severity (<50%, 50–70%, >70%).

• Post-CAG adverse effects: Pain, bleeding, allergic reaction.

Statistical Analysis: Categorical variables were analysed using chi-square or Fisher’s exact tests; continuous variables with Student’s t-test. A p-value <0.05 was considered statistically significant.

This table compares basic patient information like age, height, weight, BMI, and gender between the two groups. Diabetic patients were significantly older (higher mean age), had greater body weight, and higher BMI than non-diabetic patients (p < 0.05 using Student’s t-test). There was no significant difference in height or gender distribution. These findings suggest that the diabetic group had slightly older and heavier patients, which could contribute to higher cardiovascular risk [Table 1].

The table shows the pattern of coronary artery involvement: normal CAG, single vessel disease (SVD), double vessel disease (DVD), and triple vessel disease (TVD). In diabetic patients, multi-vessel disease (especially DVD and TVD) was much more common. In non-diabetic patients, single-vessel disease or completely normal angiograms were seen more often. The overall difference between the groups was highly significant (Pearson’s Chi-square test, p < 0.001), and individual comparisons were also significant (Fisher’s exact test, p < 0.05). This clearly indicates that diabetes is linked to more widespread coronary artery blockages [Table 2].

This table compares the degree of narrowing (stenosis) in the coronary arteries: mild (<50%), moderate (50–70%), and severe (>70%). Severe stenosis (>70%) was significantly more frequent in the diabetic group, while mild stenosis was more common in non-diabetic patients (Chi-square test, p < 0.05). This means blockages in diabetic patients were generally tighter and more dangerous [Table 3].

This table looks at complications right after the coronary angiography procedure: pain at the puncture site, bleeding/hematoma, and allergic reaction to contrast. Pain and bleeding occurred more frequently in diabetic patients compared to non-diabetics (Chi-square test, p < 0.05). Allergic reactions were very rare in both groups. The higher rate of local complications in diabetics may be due to weaker blood vessels or other diabetes-related factors [Table 4].

Discussion

The present study demonstrates that diabetic patients have more extensive and severe coronary artery disease on angiography compared to non-diabetic patients. Multi-vessel involvement, particularly triple-vessel disease, and severe stenosis (>70%) were significantly higher in diabetics, aligning with previous findings [31-37].

Similar patterns were reported by Siddiqui et al. (2023), who observed higher triple-vessel disease in diabetic females with acute coronary syndrome [32]; Girdhar et al. (2018), who noted increased multi-vessel disease, diffuse lesions, and greater stenosis in diabetics [31]; and Al Baker et al. (2023), who found higher positive lesions, multi-vessel involvement, and severe stenosis in diabetics [33]. Parvin et al. (2014), Sharma et al. (2018), Bettamer et al. (2021), Moosavi et al. (2006), and Çakır & Gören (2023) consistently reported more diffuse, extensive, and vulnerable plaque characteristics in diabetic patients [34-37].

Mechanisms such as endothelial dysfunction, chronic hyperglycemia, and AGEs contribute to accelerated atherosclerosis and plaque instability in DM [6-21]. Higher post-procedure adverse effects in diabetics may relate to vascular fragility or comorbidities.

Conclusion

Diabetic patients exhibit more severe and widespread coronary artery disease on CAG compared to non-diabetics, with increased multi-vessel involvement and severe stenosis. These findings highlight the need for early screening, strict glycemic control, and comprehensive risk-factor management to improve outcomes in this high-risk population.

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