Study Of Clinical Characteristics And Coronary Angiographicology In Patients Combined Coronary Heart Disease With Glucometabolic Abnormality

Objective: To clarify the status, characteristics of clinical and coronary artery lesions of subjects combined coronary artery disease(CAD) with glucometabolic abnormality via analyzing characteristics of clinical, coronary angiography(CAG) and 64-slice spiral compute tomography angiography(CTA);and giving theoretic basis to prevent and treat CAD.Methods: A total of 182 patients with CAD confirmed by CAG were included in this study, .42 patients received CTA before CAG.. Blood pressure, blood glucose, fasting insulin, serum lipid profile, body mass index(BMI), and so on, were determined. All the Patients with previously known diabetes mellitus(DM) were not asked to perform oral glucose tolerance test(OGTT), the others would perform OGTT to characterize the glucose metabolism status. Patients were divided into four groups according to 1999 diabetes criteria of WHO: normal glucose tolerance(NGT), impaired glucose tolerance(IGT), preclinical diabetes mellitus(PDM), diabetes mellitus(DM), respectively. comparisons in characteristics of clinical, coronary angiography(CAG) would be conducted among the four groups. patients received both CTA and CAG were divided into two groups(isolated CAD,CAD+DM), and iconographic characteristics were compared between two groups. Statistical analyses were conducted using SPSS for windows ,version 11.5. P<0.05 was considered statistically significant.Results:①There were 79 patients with glucometabolic abnormality in the 132 patients who received OGTT, patients with isolated-impaired fasting glucose(I-IFG), isolated-impaired glucose tolerance(I-IGT), IFG+IGT, isolated fasting hyperglycemia(IFH), isolated postprandial hyperglycemia(IPH) and compounded hyperglycemia(CH) were 1, 37, 3, 1, 25 and 12 respectively.②Compared with the NGT patients, IGT,PDM,DM patients suffered more from multiple vessel lesions, severe coronary artery stenosis, complete occlusions, diffuse lesions, RCA (P<0.05 or po<0.01), And their cumulative scores were higher(P<0.05 or P<0.01). Compared with the IGT and PDM patients, DM patients suffered more from triple vessel lesions, diffuse lesions(P<0.05), and cumulative scores were higher(P<0.05).③The incidence of metabolic syndrome(MS),overweight/obesity and dyslipidemia was frequent in the patients with glucometabolic abnormality(P<0.05 or P<0.01).④When employed coronary artery disease cumulative scores as the dependent variables, 2 hour plasm glucose,insulin resistance index(HOMA-IR), wrist-to-hip rate (WHR), history of diabetes mellitus, Apo-B, smoking, BMI, hypertension, family history of CAD, TG come into the stepwise regression,which are the independent predict factors of coronary artery disease.⑤CTA showed that DM+CAD group had significantly more diseased coronary segments(P<0.05), more non-occlusive plaques, calcification and noncalcified palques and less mixed plaques than isolated CAD group. The average calcification integrals was higher in the DM+CAD group(P<0.05 or P<0.01).⑥CTA was an valuable method in diagnosing CAD. sensitivity, specificity, positive , positive predictive value, negative predictive value, accuracy rate, likelihood ratio were higher in DM+CAD group, whish are 78.13%vs96.15%,97.58%vs99.45%,80.65%vs92.59%,97.19%vs99.72%,95.36%vs99.23%,32.29vs175 respectively.Conclusions:①The frequency of disturbed glucose metabolism is considerably high in inpatients with coronary heart disease, and postprandial hyperglycemia is more common. The prevalence of abnormal glucose metabolism would be obviously underestimated(78.48%) by measuring fasting plasma glucose only.②The coronary artery lesions are extensive and serious, which are positively correlated with glucose, and this phenomenon performes outstandingly in impaired glucose tolerance period.③Patients combined glucometabolic abnormality with coronary artery disease have serious metabolic disorder, and the ratio of combined with metabolic syndrome are high.④2 hour plasma glucose,insulin resistance index, wrist-to-hip rate , history of diabetes mellitus, Apo-B, smoking, BMI, hypertension, family history of coronary heart disease, Triglyceride, are the independent predict factors of coronary artery disease.⑤compute tomography angiography has outstanding diagnosis values in coronary heart disease.