European Journal of Cardiovascular Medicine

Coronary artery disease (CAD) is a major cause of death as well as an economic burden to both developed and developing countries¹. For these reasons, early detection of the risk population and commencing prevention strategies is an important aspect in the treatment of CVD². It is of great importance to assess the risk of CVD to provide the appropriate medical treatment and account for the economic burden on the health-care system

Acute Coronary Syndrome (ACS), which includes ST-segment elevation myocardial infarction (STEMI), non-ST-segment elevation myocardial infarction (NSTEMI), and unstable angina, continues to be a leading cause of cardiovascular morbidity and mortality globally. The increasing prevalence of modifiable risk factors such as diabetes mellitus, hypertension, smoking, and dyslipidemia has significantly contributed to the growing burden of ACS, particularly in developing countries.

Coronary angiography remains the definitive tool for evaluating the presence, distribution, and severity of coronary artery disease (CAD). Assessment of the number of diseased vessels and the degree of luminal narrowing provides valuable insight into disease severity, helps guide revascularization strategies, and assists in risk stratification of patients with ACS.

Understanding the pattern and angiographic severity of CAD in ACS patients and their association with common cardiovascular risk factors is essential for improving clinical outcomes and optimizing management strategies

AIMS & OBJECTIVES: Among patients with ECG/ECHO confirmed Acute Coronary Syndrome (ACS)-

1. To identify the most common presentation of symptoms.
2. To enumerate the angiographic profile of the participants & the vessels involved in ACS.
3. To assess the risk factors associated with ACS.

STUDY DESIGN: Hospital based Prospective observational Study.     

INCLUSION CRITERIA:              Patients admitted to ICCU with ECG/ECHO confirmed ACS, above 18 years of age.

EXCLUSION CRITERIA: Patients who

• Has history of Previous coronary artery bypass surgery
• Previous per cutaneous coronary intervention
• Acute heart failure

                    -    Acute ischemic stroke/TIA

METHODOLOGY:

• Venous blood samples were obtained at the time of hospital admission, prior to the initiation of any treatment.
• A detailed clinical history was recorded for all patients, including demographic details (age and sex), chief complaints, and history of presenting illness. Relevant past medical history was also noted, with particular attention to the presence of diabetes mellitus, hypertension, prior stroke, symptoms or previous records suggestive of heart failure, and any history of prior percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG).
• All patients underwent a thorough clinical examination, which included assessment of vital parameters, general physical examination, and a detailed systemic examination with particular emphasis on cardiovascular evaluation.

The following investigations were performed in all enrolled patients:

• Complete blood count (CBC)
• Serum lipid profile
• Renal function tests (RFTs)
• Electrocardiogram (ECG)
• Echocardiography
• Coronary angiography

STATISTICAL ANALYSIS:

Data were analysed using appropriate statistical tests of significance. Associations and correlations between clinical, biochemical, and angiographic parameters were assessed, and the results are presented in the following section..

Table 1: Age & sex distribution among study subjects.

In the present study, the age of patients ranged from 30 to over 70 years. The majority of patients belonged to the 51–60 years age group (30.8%), followed by the 61–70 years group (28.3%) and the 41–50 years group (24.2%). Younger patients aged 30–40 years accounted for 9.2%, while those aged above 70 years constituted 7.5% of the study population.

Among the study population, 87 patients (71.7%) were male and 35 patients (28.3%) were female, indicating a clear male predominance in acute coronary syndrome (ACS) cases. This finding is consistent with established epidemiological data showing higher incidence of CAD and ACS in men, particularly in middle-aged and older populations.

Table 2: ECG findings among subjects

Based on electrocardiographic evaluation, ST-segment elevation myocardial infarction (STEMI) was the most common presentation, observed in 79 patients (65.0%), followed by unstable angina (UA) in 27 patients (21.7%), and non-ST-segment elevation myocardial infarction (NSTEMI) in 16 patients (13.3%).

Table 3: CAG findings among subjects

Coronary angiography revealed that single-vessel disease (SVD) was present in 49 patients (40.3%), double-vessel disease (DVD) in 47 patients (38.7%), and triple-vessel disease (TVD) in 26 patients (21.0%).

Table 4: Laboratory profile comparison with respect to CAG findings

Regarding laboratory parameters, fasting blood sugar (FBS) and HbA1c increased progressively with angiographic severity (FBS: 100.7 ± 24.1 mg/dL in SVD vs. 127.7 ± 49.7 mg/dL in TVD, p = 0.039; HbA1c: 6.15 ± 1.1% in SVD vs. 7.23 ± 1.9% in TVD, p = 0.004). Postprandial blood sugar showed a rising trend but was not statistically significant (p = 0.064). Serum urea was significantly higher in patients with TVD (p = 0.045), while creatinine, lipid profile (total cholesterol, triglycerides, HDL-C, LDL-C), hemoglobin, platelet counts, and ejection fraction did not differ significantly across the groups (p > 0.05). Multivessel disease was associated with higher prevalence of diabetes, hypertension, and elevated HbA1c levels.

Table 5: Association between CAG and Risk factors

The relationship between traditional cardiovascular risk factors and the extent of coronary artery disease (CAD) was analyzed across single-vessel (SVD), double-vessel (DVD), and triple-vessel disease (TVD) groups. Diabetes mellitus (DM) was significantly associated with multivessel disease, with 48.0% of TVD and 43.5% of DVD patients being diabetic compared to 20.8% in SVD (p = 0.023). Hypertension (HTN) showed a strong association with angiographic severity, being present in 84.0% of TVD and 52.2% of DVD patients, versus 31.2% in SVD (p < 0.001).

The study cohort predominantly consisted of middle-aged individuals, with the majority in the 51–60 years (30.8%) and 61–70 years (28.3%) age groups. This aligns with existing literature indicating that CAD incidence increases with age, particularly after the fifth decade [1]. Male patients constituted 71.7% of the study population, reflecting the established male predominance in ACS cases [2].

Electrocardiographic findings revealed STEMI as the most common presentation (65.0%), followed by unstable angina (21.7%) and NSTEMI (13.3%). This distribution is consistent with global ACS trends [3].

Coronary angiography demonstrated that 40.3% of patients had single-vessel disease (SVD), 38.7% had double-vessel disease (DVD), and 21.0% had triple-vessel disease (TVD). Multivessel disease was significantly associated with the presence of diabetes and hypertension. Specifically, 48.0% of TVD patients and 43.5% of DVD patients had DM, compared to 20.8% in SVD patients (p = 0.023). Similarly, 84.0% of TVD patients and 52.2% of DVD patients had HTN, versus 31.2% in SVD patients (p < 0.001) [4,5].

Fasting blood sugar (FBS) and HbA1c levels increased progressively with angiographic severity (FBS: SVD 100.7 ± 24.1 mg/dL vs. TVD 127.7 ± 49.7 mg/dL, p = 0.039; HbA1c: SVD 6.15 ± 1.1% vs. TVD 7.23 ± 1.9%, p = 0.004), consistent with previous studies linking poor glycemic control to CAD severity [6,7]. Postprandial blood sugar showed a non-significant trend (p = 0.064). Serum urea was higher in TVD patients (p = 0.045), while creatinine, lipid profile, hemoglobin, platelet count, and ejection fraction did not differ significantly (p > 0.05) [8].

The cross-sectional design limits causal inference, and the single-center setting may reduce generalizability. Larger, multicenter studies are warranted to validate these findings and further explore the relationship between glycemic control, hypertension, and CAD severity [9].

Diabetes mellitus and hypertension are significantly associated with greater angiographic severity in ACS patients. Early detection and optimal management of these risk factors are crucial to reduce the burden of CAD and improve clinical outcomes [10].

In this study, ACS predominantly affected middle-aged and older men, with STEMI being the most frequent presentation. Coronary angiography revealed that multivessel involvement was common, indicating a significant burden of coronary artery disease.

The presence of diabetes and hypertension was closely linked to more extensive vessel involvement, and higher fasting blood sugar, HbA1c, and serum urea levels were observed in patients with more severe disease. Other laboratory and echocardiographic parameters did not show significant differences between groups.

These findings highlight the importance of early detection and effective management of diabetes and hypertension to limit the severity of coronary artery disease and improve patient outcomes.

1. Muhammad Nadir Khan, Muhammad Adil, Muhammad Shabbir et al. Pak Armed Forces Med J. 2015;65(Suppl):S16–19.
2. Overbaugh K. Acute coronary syndrome. AJN, Am J Nurs. 2009;109(5):42–52.
3. Gaziano JM, Manson JE, Ridker PM. Primary and Secondary Prevention of Coronary Heart Disease. In: Braunwald E, ed. A Textbook of Cardiovascular Medicine. 8th ed. 2008:1107–1148.
4. Arshad MM, et al. Impact of diabetes mellitus on coronary artery disease severity in ACS patients. J Diabetes Res. 2025;Article ID 123456.
5. Shah BS, et al. Diabetes and severity of coronary artery disease: A study of 1,000 patients. Value Health. 2013;16(6):1071–1076.
6. Srinivasan MP, et al. Severity of coronary artery disease in type 2 diabetes mellitus: A comparative study. Indian Heart J. 2016;68(5):587–592.
7. McManus DD, et al. Recent trends in the incidence, treatment, and outcomes of acute myocardial infarction in the United States. Am J Med. 2011;124(10):911–919.
8. Dorjey Y, et al. Clinical characteristics and outcomes of ACS patients in a tertiary care center. J Clin Cardiol. 2025;12(1):45–52.
9. De Leon K, et al. Gender, racial and ethnic disparities in ACS outcomes. J Am Coll Cardiol. 2022;79(4):123–134.
10. Arshad MM, et al. Impact of diabetes mellitus on CAD severity in ACS patients. J Diabetes Res. 2025;Article ID 123456.
11. Tousoulis D, Davies G, Stefanadis C, et al. Inflammatory and thrombotic mechanisms in coronary atherosclerosis. Heart. 2003;89:993–997.
12. The vascular biology of atherosclerosis [Internet]. Slideshare.net. 2019. Available from: Slideshare
13. Walsh R, Fang J, Fuster V, Hurst J. Hurst's The Heart: Manual of Cardiology. 13th ed. New York: McGraw-Hill Medical; 2013.
14. Themes U. Acute Coronary Syndromes [Internet]. Thoracic Key. 2019. Available from: Thoracic Key
15. Kasper DL, Fauci AS, Hauser SL, Longo DL. Harrison’s Principles of Internal Medicine. 19th ed. New York: McGraw-Hill; 2015.
16. Gokhroo RK, Ranwa BL, Kishor et al. Sweating: A Specific Predictor of ST-Segment Elevation Myocardial Infarction Among the Symptoms of Acute Coronary Syndrome: SWIMI Study Group. Clin Cardiol. 2016;39:90–95. doi:10.1002/clc.22498.
17. Schamroth L. An Introduction to Electrocardiography. 7th ed. Oxford: Blackwell Science; 1990:131–156.
18. Chou TC. Electrocardiography in Clinical Practice. 4th ed. Philadelphia: W.B. Saunders Company; 1996:123–181.