الفهرس 
Aim of the workOnly 14 pages are availabe for public view
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Abstract
Coronary artery disease is a major cause of death and disability in developed countries and remains responsible for about one third of all deaths in individuals over age 35. Diabetes mellitus is a well-established risk factor for the development of coronary artery disease. which is the major cause of premature death in diabetic patients. At present insulin resistance known to be apathogenic cause that can predict the occurrence of coronary artery disease so grading of severity of coronary artery disease based on insulin resistance which determined by fasting insulin level has been studied in detail in our study.
The aim of our study was designed to evaluate the correlation between insulin resistanceand severity of coronary artery disease measured by Gensini Score in these patients.
Methods: This study enrolled eighty four diabetic patients who presented to the cath Lab for elective coronary angiography based on symptoms and investigations suggestive of ischemic heart disease in the period (octobar 2019 to april 2020).
All patients were subjected to full history taking, thorough clinical examination, laboratory investigations (fasting insulin level, HbA1c level, lipid profile and serum creatinine), ECG, echocardiography examination and coronary angiography (severity of the coronary artery lesions was evaluated using Gensini score.
Results: In our study we found highly significant relation between insulin level and hypertention (P-value <0.001) and significant relation between insulin level and dyslipidemia (P-value <0.05) but regarding cigarette smoking and past family history of CADS there is no diffrance (P-value >0.05)
there were no statistical significant difference between the studied groups as regard age and sex (P-value >0.05).
hypertension was more prevalent in patients with coronary artery disease than those with normal coronary (P-value <0.001).But no statistical significant difference between the studied groups as regard smoking, dyslipidemia and family history (P-value >0.05).
LVESD was slightly larger in patients with sever coronary artery diseases compared to other groups (P-value <0.001). But no significant difference was found between the studied groups as regard LVEDD (P-value >0.05). More over EF% was significantly lower in patients with sever coronary artery disease than other groups (P-value <0.001).
Insulin level was significantly higher in patients with CAD than those with normal coronaries (P-value<0.001), moreover it was significantly higher in patients with severe CAD than those with mild and moderate CAD (P-value <0.001), and in patients with moderate CAD than those with mild CAD (P-value <0.001).
Similarly HbA1c was significantly higher in patients with CAD than those with normal coronaries (P-value <0.001), moreover it was significantly higher in patients with severe CAD than those with mild (P-value<0.001) and significant in patients moderate CAD than those with mild CAD (P-value<0.05).
Summary
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As regard total cholesterol and TG they were significantly higher in patients with moderate and severe CAD than those with normal coronaries (P-value <0.05). As regard LDL level it was significantly higher in patients CAD than those with normal coronaries (P-value <0.05). In the contrary HDL level was significantly lower in patients with CAD than those with normal coronaries (P-value<0.001), moreover it was significantly lower in patients with severe CAD than those with mild and moderate CAD (P-value <0.001), and in patients with moderate CAD than those with mild CAD (P-value <0.001).
A statistically highly significant positive linear correlation was found between insulin level and severity of coronary artery disease as assessed by Gensini Score (P< 0.001) in type 2 diabetic patients and there was a statistically highly significant negative linear correlation between insulin level and EF% assessed by echocardiography examination (P-value<0.001) in type 2 diabetic patients. But there was not significant correlation between fasting insulin level and duration of diabetes as (P >0.05).
The results derived from the ROC curve showed that Gensini score has 96.7% sensitivity, 75% specificity, accuracy 96.6%. and a cut off predictive value ≥ 25.8 mIU/L.