Association of Diabetic Retinopathy with Angiographic Severity of Coronary Artery Disease in Patients with Non-ST Elevation Myocardial Infarction

Heru Al Amin, Amal Kumar Choudhury, Syed Ali Ahsan, Bijoy Dutta, Mujtahid Mohammad Hossain, Nur Alam, Kofil Uddin, Partha Pratim Saha

Background: Bed side ophthalmoscopy examination is a simple measure of diagnosis of diabetic
retinopathy and has been shown to be a predictor of poor outcome in various cardiovascular conditions
including coronary artery disease. The present study was intended to find the relationship between
diabetic retinopathy with the severity of coronary artery disease in patients with non ST elevation
myocardial infarction (NSTEMI).
Methods: This cross-sectional observational study was conducted with a total of 120 NSTEMI patients
with diabetes undergoing coronary angiogram and also fundoscopic examination with fundal photography
during the index hospitalization. Study subjects were divided into two groups on the basis of diabetic
retinopathy (Group-I: NSTEMI with diabetic retinopathy; Group- II: NSTEMI without diabetic
retinopathy). Severity of coronary artery disease was determined by Gensini score and correlation between
diabetic retinopathy and Gensini score was assessed.
Results: Gensini score was significantly higher in patients with diabetic retinopathy than that in patients
without diabetic retinopathy (62.2±27.7 vs. 43.3±25.3, p<0.001).Gensini score increased with increasing
severity of diabetic retinopathy (p <0.001).The risk of having severe CAD in patient with diabetic
retinopathy was 13.03 (95% CI =2.410-70.419) (P<0.003). A significant correlation between diabetic
retinopathy and Gensini score was noted (p value <0.001)
Conclusion: It may be concluded that presence and severity of diabetic retinopathy is associated with
angiographic severe coronary artery disease in patient with NSTEMI and it may be considered as an
independent predictor of severity of CAD. As is a bed side assessment, so before performing coronary
angiography, it appears to be additive for risk stratification.