Clinical and angiographic profile of early-onset type 2 diabetes mellitus in acute coronary syndrome

Early-onset type 2 diabetes mellitus has been recognized as a distinct phenotype with a probable unique pathophysiology in recent years. Although well known to have an aggressive clinical and metabolic phenotype, with rapid development of vascular complications, studies regarding coronary artery disease in this group are sparse, especially in the Indian context. A cross-sectional study was conducted in Kasturba Medical College, Manipal, between October 2015 and May 2017. Sixty-three adult patients with early-onset type 2 diabetes mellitus presenting with an acute coronary syndrome were included. Early-onset type 2 diabetes mellitus (T2DM) was defined as onset of type 2 diabetes mellitus at less than 45 years of age. Fasting and post prandial sugar levels, fasting lipid profile, and HbA1c levels were obtained. All patients underwent conventional angiography using the Seldinger technique. Coronary artery disease was evaluated using the SYNTAX score. Mitral regurgitation and left ventricular dysfunction were assessed using conventional transthoracic echocardiography. Patients had a poor metabolic profile and clustering of cardiovascular risk factors, with high BMI, poorly controlled diabetes mellitus, and dyslipidemia. Majority of the patients had triple/multi-vessel disease, with moderate to high SYNTAX scores. A significant number of patients required were advised CABG. Significant number of patients had mitral regurgitation and left ventricular dysfunction. Early-onset type 2 diabetes mellitus is an aggressive phenotype. More studies are necessary to elucidate its impact on coronary vasculature and pattern of coronary artery disease.