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Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako

Received: 26 February 2024     Accepted: 9 March 2024     Published: 2 April 2024
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Abstract

Introduction: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. Objective: to identify the results of coronary angiography in diabetic patients. Patients and method: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. Results: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. Conclusion: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.

Published in Cardiology and Cardiovascular Research (Volume 8, Issue 1)
DOI 10.11648/j.ccr.20240801.17
Page(s) 46-50
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Diabetes, Coronary Angiography, CHU Mother Child Luxembourg, Bamako

1. Introduction
Diabetes is a metabolic disease characterized by chronic hyperglycemia. It is growing rapidly in Africa according to the International Diabetes Federation . It is an important risk factor for the development of coronary heart disease . Diabetic patients are at high risk of developing cardiovascular disease with its various manifestations such as ischemic heart disease, heart failure, stroke and peripheral arterial disease . People with type 2 diabetes have a two- to four-fold increased risk of developing cardiovascular disease in their lifetime, including coronary artery disease, stroke, heart failure, atrial fibrillation, as well as peripheral arterial disease . Diabetes is a well-established risk factor for ischemic heart disease, and coronary artery disease accounts for 40–80% of the causes of death in patients with type 2 diabetes . In patients with chronic coronary syndrome (CTS), type 2 diabetes is also associated with an increased risk of cardiovascular events (cardiovascular death, myocardial infarction, or stroke) . Studies have shown that the clinical signs of coronary artery disease in diabetic patients are often less severe and atypical in presentation. In the BARI 2D (Bypass Angioplasty Revascularization Investigation 2 Diabetes) trial in patients with angiography-confirmed coronary artery disease and diabetes with a mean duration of 10.4 years, typical angina, anginal equivalent, or a combination of both were observed in 19%, 21%, and 42% of patients, respectively, while 18% remained asymptomatic . In a study of 510 asymptomatic diabetic patients with a mean age of 53 years with no history of cardiovascular disease, calcium score revealed coronary calcifications considered a reliable marker of coronary atherosclerosis in 46.3% of patients . Diabetes is a major cardiovascular risk factor. Its complications are microangiopathic and macroangiopathic, including cardiovascular involvement. Cardiovascular morbidity and mortality is high in diabetics compared to non-diabetics . Exploration of the heart for coronary atherosclerosis is important in diabetic patients, hence the motivation for this study.
2. Patients and Methods
We conducted a descriptive, cross-sectional study with retrospective recruitment that took place over a three-year period from September 2019 to February 2023. All diabetic patients who underwent coronary angiography at the mother-Child University Hospital in Bamako, Luxembourg were included. Information was collected for each patient on an individual survey sheet. Data were collected from clinical and paraclinical examination with coronary angiography results. This coronary angiography was performed using a General Electric Optima device. Socio-demographic characteristics, functional signs, and indications were collected. Other cardiovascular risk factors, namely high blood pressure (hypertension), smoking, dyslipidemia, sedentary lifestyle, obesity and cardiovascular heredity, were sought. Significant lesions on coronary angiography were defined by the presence of a stenosis greater than 50% in the common trunk and proximal interventricular, greater than or equal to 70% for the other sites and between 50 and 70% with typical angina.
Data were captured from the French version 22.0 of the SPSS software and analyzed with the same software. The word processor was done on Microsoft Office Word 2016.
The statistical test used was the Fisher test and p was statistically significant if < 0.05. Confidentiality was respected and data processing was anonymous.
3. Results
During the study period, 985 coronary angiography angiography was performed in the interventional cardiology unit. Of these patients, 371 were diabetic, representing a hospital frequency of 37.66%. The mean age of patients was 60.76 +/- 10.26 years with extremes of 32 and 84 years. The majority age group was 58-71 years with a proportion of 43.7% (Table 1). The predominance was male with a sex ratio of 1.45. The predominant functional signs were typical chest pain 39.4%, atypical chest pain 27.8%, and dyspnea 13.2% (Table 1). The predominant risk factors were hypertension 74.7%; a sedentary lifestyle 48.8% and smoking 17.5% (Table 1). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%) (Table 2). Coronary angiography was pathological in 78.4% with tritruncular involvement in 38% and bitruncular involvement in 21% (Table 2). The lesions were located on the common trunk in 5.7%; on the anterior ventricular interventricular in 58.1%; on the circumflex in 46.5% and on the right coronary in 50.1% (Table 1).
Table 1. Epidemiological and clinical features.

Characteristics

Men n= 220

Women n= 151

Total

No

%

No

%

No

%

Age range

[32-45]

17

7,7

13

8,6

30

8,1

]45-58]

78

35,5

46

30,5

124

33,4

]58-71]

94

42,7

68

45

162

43,7

]71-84]

31

14,1

24

15,9

55

14,8

Cardiovascular Risk Factors

HTA

161

73,2

116

76,8

277

74,7

Sedentary lifestyle

87

62,3

94

39,5

181

48,8

Smoking

63

28,6

2

1,3

65

17,5

Obesity

19

8,7

20

13,2

39

10,5

ATCD Coronary artery disease

23

10,5

9

6

32

8,6

Dyslipidemia

19

8,6

8

5,3

27

7,3

Functional Signs

Pain thoracic Typical

94

42,7

52

34,4

146

39,4

Pain thoracic Atypical

61

27,7

42

27,8

103

27,8

Dyspnoea

30

13,7

19

12,6

49

13,2

Asymptomatic

28

12,7

17

11,3

45

12,1

Table 2. Characteristics Coronary angiography.

Characteristics Coronary angiography

Men n= 220

Women n= 151

Total

P

No

%

No

%

No

%

Directions

ACS

101

45,9

66

43,7

167

45

0,7

ST +

70

31,8

39

25,8

109

29,4

0,2

ST-

31

14,1

27

17,9

58

15,6

0,3

CCS

120

54,5

84

55,6

204

55

0,9

Pathological coronary angiography

181

82,3

110

72,8

291

78,4

0,02

Mono truncular

40

18,2

32

21,2

72

19,4

0,5

Bi truncular

50

22,7

28

18,5

78

21

0,3

Tritruncular

91

41,4

50

33,1

141

38

0,1

Artère coupable

Anterior interventricular artery

139

63,2

83

55

222

59,8

0,1

Right Coronary

118

53,6

74

49

192

51,8

0,3

Circumflex artery

110

50

66

43,7

176

47,4

0,2

Common Core

14

6,4

6

4

20

5,4

0,3

Bisector

14

6,4

3

2

17

4,6

0,03

4. Discussion
Diabetes is a metabolic disease that is growing rapidly in Africa due to the epidemiological transition. Among patients who performed coronary angiography during the study period, the proportion of diabetic patients was 37.66%. This proportion is higher than that found by Dioum . in Dakar which was 24.5% and that found by N'Guetta . in Abidjan which was 18.5%. This difference could be explained by the period of study. Diabetes is a metabolic disease that is growing rapidly in Africa due to the epidemiological transition. Among patients who performed coronary angiography during the study period, the proportion of diabetic patients was 37.66%. This proportion is higher than that found by Dioum . in Dakar which was 24.5% and that found by N'Guetta . in Abidjan which was 18.5%. This difference could be explained by the period of study. In Nigeria . the proportion of diabetics among patients who underwent coronary angiography was 33.8%. In North Africa, particularly Tunisia, the proportion of diabetic patients was about 40% . Diabetes is a major cardiovascular risk factor and its frequency increases with age. In our series, the mean age of patients was 60.76+/- 10.26 years with extremes of 32 and 84 years. This average age is close to those found by Dioum . in Dakar 61.8 years and N'Guetta . in Abidjan 58.7 years old. This is a testament to the fact that this pathology affects people who are in employment. Male sex is considered a non-modifiable cardiovascular risk factor. The predominance was male in our patients with a sex ratio of 1.45. The same observation was made in Abidjan with a sex ratio of 7 and in Dakar with a sex ratio of 1.97.
Diabetes is characterized by neuropathy which is part of microangiopathy. The clinical manifestations of ischemic heart disease in diabetics are diverse. In our patients, the predominant functional signs were typical chest pain in 39.4%, atypical chest pain in 27.8%, and dyspnea in 13.2%. In Dakar, Dioum . found 70.3% of patients asymptomatic, chest pain in 21.8% and dyspnea in 7.9%. Other cardiovascular risk factors may be associated with diabetes. In addition to diabetes, we have observed in our patients certain predominant risk factors such as hypertension 74.7%; a sedentary lifestyle 48.8% and smoking 17.5%. In West Africa, hypertension was found as a major cardiovascular risk factor associated with diabetes in Abidjan according to N'Guetta with 75%, followed by a sedentary lifestyle 32.5% and smoking 5%. In Dakar, Dioum . found that diabetics had the associated risk factors following a sedentary lifestyle (59.4%), followed by hypertension (49.5%) and smoking (9.9%). The motivations for performing coronary angiography in diabetic patients are diverse. In our patients, the indications for coronary angiography were mainly CCS in 55% and ACS in 45%.
This is in agreement with the proportions found by Parvin . in Bangladesh which were 71% for SCC and 29% for SCA. In Abidjan, N'Guetta . had performed coronary angiography in front of an ACS in 71.2% and in front of a SCC in 26.3%. In Dakar, according to Dioum’s study, coronary angiography was performed in front of an ACS in 48.5% and the CCS in 35.7% . In our series, coronary angiography was pathological in 7 Coronary lesions in diabetics are classically characterized by their diffuse and extensive appearance. The lesions were tritruncular in 38% and bitruncular in 21% in our series. These rates can be superimposed on those of N'Guetta in Abidjan, which were 30% for bitruncular; and 57.5% for tritruncular. In Dakar , the lesions were bi-truncular in 42.9% and tritruncular in 38.1%.8.4%, this rate is close to 85% in Abidjan , and 83.1% in Dakar . The damage was localized to the common core in 5.7%; on Anterior interventricular artery in 58.1%; on the circumflex in 46.5% and on the right coronary in 50.1%. In Abidjan , 0.8% of students reached the common core; 38.8% for Anterior interventricular artery; 31.4% for the circumflex and 28.9% for the right coronary. In Dakar, the common core was achieved in 28.6% and the Anterior interventricular artery in 69% of cases .
5. Conclusion
The diabetic patient is at high cardiovascular risk. This cardiovascular risk is related to the risk of coronary artery disease. In our study, coronary angiography was performed in the majority of cases for chronic coronary syndrome. Coronary angiography was pathological in more than 3/4 of patients with diffuse and severe lesions.
Abbreviations
ACS: Acute Coronary Syndrom
CCS: Chronic Coronary Syndrome
USTTB: University of Science, Technique and Technology of Bamako
Conflicts of Interest
The authors declare no conflict of interest.
References
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[5] Chan JC, Lim LL, Wareham NJ, Shaw JE, Orchard TJ, Zhang P, et al. The Lancet Commission on diabetes: using data to transform diabetes care and patient lives. The Lancet. 2020; 396(10267): 2019-82.
[6] Rawshani A, Rawshani A, Franzén S, Eliasson B, Svensson AM, Miftaraj M, et al. Mortality and Cardiovascular Disease in Type 1 and Type 2 Diabetes. N Engl J Med. 13 avr 2017; 376(15): 1407-18.
[7] Krempf M, Parhofer KG, Steg PG, Bhatt DL, Ohman EM, Röther J, et al. Cardiovascular event rates in diabetic and nondiabetic individuals with and without established atherothrombosis (from the REduction of Atherothrombosis for Continued Health [REACH] Registry). Am J Cardiol. 2010; 105(5): 667-71.
[8] Mak KH, Vidal-Petiot E, Young R, Sorbets E, Greenlaw N, Ford I, et al. Prevalence of diabetes and impact on cardiovascular events and mortality in patients with chronic coronary syndromes, across multiple geographical regions and ethnicities. Eur J Prev Cardiol. 2021; 28(16): 1795 806.
[9] Krishnaswami A, Hardison R, Nesto RW, Sobel B. Presentation in Patients With Angiographically Documented Coronary Artery Disease and Type II Diabetes Mellitus (from the BARI 2D Clinical Trial). Am J Cardiol. janv 2012; 109(1): 36-41.
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[12] N’Guetta R, Yao H, Ekou A, Séri B, N’Cho-Mottoh MP, Soya E, et al. Coronary artery disease in black African patients with diabetes: Insights from an Ivorian cardiac catheterization centre. Arch Cardiovasc Dis. mai 2019; 112(5): 296-304.
[13] Falase B, Johnson A, Animasahun B, Akinbileje T, Onabowale Y, Oke D. Clinical and Angiographic Profile of Nigerians with Coronary Artery Disease. Exp Clin Cardiol. 1 janv 2014; 20: 398-410.
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Cite This Article
  • APA Style

    Mamadou, T., Massama, K., Mariam, S., Samba, S., Souleymane, M., et al. (2024). Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako. Cardiology and Cardiovascular Research, 8(1), 46-50. https://doi.org/10.11648/j.ccr.20240801.17

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    ACS Style

    Mamadou, T.; Massama, K.; Mariam, S.; Samba, S.; Souleymane, M., et al. Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako. Cardiol. Cardiovasc. Res. 2024, 8(1), 46-50. doi: 10.11648/j.ccr.20240801.17

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    AMA Style

    Mamadou T, Massama K, Mariam S, Samba S, Souleymane M, et al. Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako. Cardiol Cardiovasc Res. 2024;8(1):46-50. doi: 10.11648/j.ccr.20240801.17

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  • @article{10.11648/j.ccr.20240801.17,
      author = {Touré Mamadou and Konaté Massama and Sako Mariam and Sidibé Samba and Mariko Souleymane and Traoré Djénébou and Sow Djénéba Sylla and Thiam Coumba Adiaratou and Sonfo Boubacar and Ba Hamidou Oumar and Menta Ichaka},
      title = {Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako
    },
      journal = {Cardiology and Cardiovascular Research},
      volume = {8},
      number = {1},
      pages = {46-50},
      doi = {10.11648/j.ccr.20240801.17},
      url = {https://doi.org/10.11648/j.ccr.20240801.17},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20240801.17},
      abstract = {Introduction: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. Objective: to identify the results of coronary angiography in diabetic patients. Patients and method: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. Results: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. Conclusion: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.
    },
     year = {2024}
    }
    

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  • TY  - JOUR
    T1  - Aspects of Coronary Angiography in Diabetic Patients at the CHU Mother and Child Luxembourg in Bamako
    
    AU  - Touré Mamadou
    AU  - Konaté Massama
    AU  - Sako Mariam
    AU  - Sidibé Samba
    AU  - Mariko Souleymane
    AU  - Traoré Djénébou
    AU  - Sow Djénéba Sylla
    AU  - Thiam Coumba Adiaratou
    AU  - Sonfo Boubacar
    AU  - Ba Hamidou Oumar
    AU  - Menta Ichaka
    Y1  - 2024/04/02
    PY  - 2024
    N1  - https://doi.org/10.11648/j.ccr.20240801.17
    DO  - 10.11648/j.ccr.20240801.17
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 46
    EP  - 50
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20240801.17
    AB  - Introduction: Type 2 diabetes is on the increase in Africa as a result of the epidemiological transition. Cardiovascular complications, particularly ischemic complications, are common in diabetic patients. They are life-threatening. It is important to identify the angiographic appearance of the coronary arteries in diabetic patients in order to guide treatment. Objective: to identify the results of coronary angiography in diabetic patients. Patients and method: Descriptive, cross-sectional study with retrospective recruitment over a three-year period from September 2019 to August 2022. All diabetic patients who underwent coronary angiography at the CHU mother child Luxembourg in Bamako were included. Results: We enrolled 371 patients out of 985 during the study period, i.e. a hospital frequency rate of 37.66%. The mean age of the patients was 60.76 +/- 10.26 years, with extremes of 32 and 84 years. They were predominantly male, with a sex ratio of 1.45. The predominant functional signs were typical chest pain (39.4%), atypical chest pain (27.8%) and dyspnea (13.2%). The predominant risk factors were hypertension (74.7%), sedentary lifestyle (48.8%) and smoking (17.5%). The indications for coronary angiography were chronic coronary syndrome (55%) and acute coronary syndrome (45%). Coronary angiography was pathological in 78.4% of patients, with tritruncular lesions in 38% and bi-truncal lesions in 21%. Lesions were located on the common trunk in 5.4%, on the anterior interventricular in 59.8%, on the right coronary in 51.8% and on the circumflex in 47.4%. Conclusion: Ischemic heart disease is common in diabetic patients with tri- and bi-truncular lesions.
    
    VL  - 8
    IS  - 1
    ER  - 

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Author Information
  • Department of Cardiology Mother and Child Luxembourg, University of Sciences, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Department of Cardiology Gabriel TOURE Hospital, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Department of Cardiology Mother and Child Luxembourg, University of Sciences, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Department of Medicine, Mali Hospital, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Department of Cardiology Mother and Child Luxembourg, University of Sciences, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Department of Medicine, Timbuktu Hospital, Timbuktu, Mali

  • Department of Cardiology Mother and Child Luxembourg, University of Sciences, Techniques and Technology of Bamako (USTTB), Bamako, Mali

  • Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Department of Cardiology Gabriel TOURE Hospital, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali

  • Department of Cardiology Gabriel TOURE Hospital, Techniques and Technology of Bamako (USTTB), Bamako, Mali; Faculty of Medicine and Odonto-Stomatology, USTTB, Bamako, Mali