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STUDIES ON THE SEVERITY AND EXTENT OF CORONARY ATHEROSCLEROSIS UTILIZING COMPUTER-ASSISTED QUANTIFICATION OF CORONARY ANGIOGRAMS With special reference to diabetes mellitus

Background. Studies have shown contradictory results with regard to the severity and extent of coronary artery disease (CAD) in the diabetic population. Despite this, common clinical opinion suggests that diabetic patients with coronary artery disease (CAD) have an extensive and diffuse type of disease affecting particularly the distal parts of the coronary vessels. This view may raise the threshold for invasive examinations and worsen possibilities for early detection of CAD. However, early enough treatment of CAD with coronary artery bypass surgery or with percutaneous coronary interventions is extremely important for diabetic patients who are at high risk for adverse outcome or even death after their first acute coronary event such as myocardial infarction. Aims. The present studies were undertaken to discover whether a) the angiographic severity and extent of CAD differ quantitatively between type 2 diabetic and nondiabetic, and type 1 diabetic and nondiabetic patients undergoing clinically indicated coronary angiography, and b) to investigate risk factors that may be related to the anatomical distribution of CAD in diabetic patients and in subjects from high-risk families. Subjects. The study population in Studies I and II comprised 57 consecutive type 2 diabetic patients undergoing clinically indicated elective coronary angiography at Helsinki University Central Hospital between September 1989 and February 1992. Each patient had type 2 diabetes fulfilling the World Health Organization 1980 criteria and, by coronary angiogram, at least one > 50% severe stenosis. A corresponding number of nondiabetic CAD patients were individually matched with type 2 diabetes patients by sex, age, and body mass index. Study III comprised 46 men in the diabetic and 42 men in the nondiabetic group. For Study IV, patients with type 1 diabetes who underwent cardiac catheterization for symptoms of CAD at the Helsinki University Central Hospital between 1982 and 1997 were identified. All the 72 patients had previously diagnosed diabetes fulfilling the World Health Organization 1980 criteria for type 1 diabetes mellitus. Nondiabetic controls from the same population were matched individually with the diabetic patients for sex, age, date of angiography, and serum creatinine value. Study V comprised 51 asymptomatic members of high-risk families identified at Kuopio University Hospital that were siblings of patients with premature severe CAD. Methods. Third-generation quantitative coronary angiography software were used in the analysis of coronary angiograms. We created a novel computer-assisted quantitative coronary angiography-based scoring system for evaluation of the severity and extent of CAD. These indices of