Angiographic Severity of Coronary Artery Disease in Diabetic vs. Non-Diabetic Patients Presenting With NSTEMI: A Comparative Cross-Sectional Study

Abstract

Objectives: Diabetes mellitus (DM) is a major cardiovascular risk factor associated with diffuse and aggressive atherosclerosis, yet contemporary data comparing angiographic severity between diabetic and non-diabetic patients with Non-ST Elevation Myocardial Infarction (NSTEMI) remain limited in South Asia. Understanding these differences is critical for improving risk stratification and guiding timely intervention. Methodology: This comparative cross-sectional study included 200 NSTEMI patients—100 diabetics and 100 non-diabetics—enrolled after screening 298 consecutive cases. Clinical, biochemical, and angiographic characteristics were recorded. Coronary artery disease (CAD) severity was quantified using the Gensini score. Regression analyses (linear and logistic) were performed to identify independent predictors of severe CAD, with model adjustments made for metabolic and cardiovascular risk factors. Results: Diabetic patients demonstrated a significantly more adverse metabolic profile, including higher HbA1c, increased creatinine, and greater prevalence of dyslipidemia (all p < 0.001). Angiographically, diabetics exhibited a higher mean Gensini score (83.88 ± 31.09) than non-diabetics (59.02 ± 34.37; p < 0.001), and a markedly higher frequency of triple-vessel disease (43% vs. 21%; p = 0.001). In multivariate analyses, diabetes mellitus (OR 3.12; 95% CI: 1.68–5.80; p < 0.001) and dyslipidemia (OR 2.24; 95% CI: 1.21–4.16; p = 0.010) remained strong independent predictors of severe CAD. Conclusion: Diabetes mellitus is strongly associated with more widespread and severe coronary artery involvement in NSTEMI patients. These findings highlight the need for earlier risk identification, aggressive metabolic control, and timely invasive evaluation among diabetic individuals presenting with ACS.