Abstract
Background:Patients with type 2 diabetes (T2DM) are at high risk for cardiovascular events and present more severe coronary artery disease (CAD). The Gensini and COURAGE scores are established angiographic instruments to assess CAD severity, which may also predict future cardiovascular risk. However, it is unclear if these scores are able to depict the increased risk of patients with T2DM and stable CAD (T2DM-SAP).Methods:We performed quantitative coronary angiography and assessed the Gensini and COURAGE scores in 124 patients with T2DM-SAP. Angiographic data were compared to patients with stable angina without T2DM (Non-DM-SAP, n = 74), and to patients with acute coronary syndrome and T2DM (T2DM-ACS, n = 53).Results:T2DM-SAP patients had similar Gensini and COURAGE-scores compared to Non-DM-SAP-patients (Gensini: 14.44 ± 27.34 vs 11.49 ± 26.99, p = 0.465; COURAGE: 3.48 ± 4.49 vs 3.60 ± 4.72, p = 0.854). In contrast, T2DM-SAP patients had significantly lower Gensini (14.44 ± 27.34 vs 30.94 ± 48.74, p = 0.003) and lower COURAGE (3.48 ± 4.49 vs 5.30 ± 4.63, p = 0.016) scores compared to T2DM-ACS-patients.Conclusion:Both the Gensini and the COURAGE score fail to predict the high cardiovascular risk of patients with T2DM-SAP. Therefore, these scores should be used with caution in the assessment of future risk of patients with T2DM. However, among T2DM-ACS patients, both scores are increased, reflecting the high cardiovascular risk in this patient population.
Highlights
Patients with type 2 diabetes mellitus (T2DM) have an enhanced risk to develop coronary artery disease (CAD) with higher disease-related morbidity and mortality rates compared to patients without TD2M.1–5 patients with T2DM without a previous history of myocardial infarction (MI) have a similar risk of subsequent cardiovascular events as patients without T2DM but with a history of MI.[2]
The main findings of the current investigation are: 1. T2DM-stable angina pectoris (SAP) patients do not show any significant difference in the severity of CAD as assessed by both the Gensini and the COURAGE scores when compared to Non-DM-SAP patients
In the present study we extend the current knowledge by demonstrating no significant difference in the angiographic severity of atherosclerosis among patients with SAP independently of the presence of T2DM
Summary
Patients with type 2 diabetes mellitus (T2DM) have an enhanced risk to develop coronary artery disease (CAD) with higher disease-related morbidity and mortality rates compared to patients without TD2M.1–5 patients with T2DM without a previous history of myocardial infarction (MI) have a similar risk of subsequent cardiovascular events as patients without T2DM but with a history of MI.[2]. Patients with type 2 diabetes (T2DM) are at high risk for cardiovascular events and present more severe coronary artery disease (CAD). The Gensini and COURAGE scores are established angiographic instruments to assess CAD severity, which may predict future cardiovascular risk. It is unclear if these scores are able to depict the increased risk of patients with T2DM and stable CAD (T2DM-SAP). Conclusion: Both the Gensini and the COURAGE score fail to predict the high cardiovascular risk of patients with T2DM-SAP. These scores should be used with caution in the assessment of future risk of patients with T2DM. Among T2DM-ACS patients, both scores are increased, reflecting the high cardiovascular risk in this patient population
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