IMPACT OF DIABETES MELLITUS ON STEMI PRESENTATION AND CORONARY VESSEL DISEASE IN PATIENTS UNDERGOING PCI: A CROSS-SECTIONAL STUDY

Background: ST-segment elevation myocardial infarction (STEMI) remains one of the most critical manifestations of coronary artery disease, contributing significantly to global morbidity and mortality. Diabetes mellitus (DM) is recognized as an independent risk factor for adverse cardiovascular outcomes and is often associated with more complex coronary artery involvement. However, the specific relationship between diabetes and the angiographic patterns of STEMI in South Asian populations undergoing percutaneous coronary intervention (PCI) remains insufficiently characterized. Objective: This study aimed to compare the extent of coronary vessel disease and the type of STEMI presentation between diabetic and non-diabetic patients undergoing PCI, while also describing their demographic, clinical, and procedural characteristics. Methods: A cross-sectional observational study was conducted at the Peshawar Institute of Cardiology from January to June 2025. A total of 150 patients with STEMI who underwent PCI were enrolled. Inclusion criteria required age ≥18 years, confirmation of STEMI through clinical presentation, electrocardiographic changes, and elevated cardiac biomarkers. Patients with prior CABG, advanced malignancy, or end-stage renal failure were excluded. Data collected included demographics, comorbidities, initial troponin levels, angiographic findings, and procedural characteristics. Patients were stratified by diabetes status. Descriptive statistics and chi-square tests were applied, with significance set at p < 0.05. Results: The mean age of patients was 58.03 ± 10.74 years (range 34–79), with 71.3% males and 28.7% females. Hypertension (68%) and diabetes (28%) were the most frequent comorbidities, followed by tobacco use (14%). Initial troponin values ranged from 2.0 to 50,000 ng/mL (mean 12,111.50 ± 18,556.98). Coronary angiography revealed single-vessel disease in 44.0%, double-vessel disease in 36.7%, and triple-vessel disease in 19.3%. Among diabetic patients (n = 42), single-vessel disease was present in 42.9%, double-vessel in 35.7%, and triple-vessel in 21.4%. In the same group, 47.6% underwent PCI for primary indication, while anterior, lateral, and inferior wall STEMI presentations were seen in 19.0%, 23.8%, and 9.5% respectively. Statistical analysis demonstrated no significant association between diabetes and vessel involvement (p = 0.921) or type of STEMI presentation (p = 0.804). Conclusion: Diabetes mellitus was not significantly associated with the angiographic extent of coronary disease or the clinical presentation of STEMI in this cohort. These findings underscore the importance of comprehensive risk factor management in all STEMI patients undergoing PCI, regardless of diabetic status.