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Prognostic Value of Coronary Computed Tomography Angiography in Patients With Diabetes: A Meta-analysis
Csilla Celeng1, Pál Maurovich-Horvat1, Brian B Ghoshhajra2
1MTA-SE Cardiovascular Imaging Research Group, Heart and Vascular Center, Semmelweis University, Budapest, Hungary.
Insights
Coronary computed tomography angiography (CTA) helps identify high-risk diabetes patients with coronary artery disease (CAD). CTA can rule out future cardiac events, guiding aggressive treatment and improving survival.
Area of Science:
- Cardiology
- Radiology
- Medical Diagnostics
Background:
- Coronary artery disease (CAD) poses a significant risk to patients with diabetes.
- The prognostic value of coronary computed tomography angiography (CTA) in this population remains unclear.
Purpose of the Study:
- To determine the prognostic value of CTA in patients with diabetes.
- To evaluate CTA's ability to predict adverse cardiovascular events in diabetic individuals.
Main Methods:
- Meta-analysis of 8 studies involving 6,225 participants.
- Collected data on event rates and hazard ratios (HR) for CTA findings.
- Calculated prevalence of obstructive and nonobstructive CAD, annualized event rates, and pooled HR.
Main Results:
- Prevalence of obstructive CAD was 38%, nonobstructive 36%, and no CAD 25%.
- Annualized event rates were 17.1% (obstructive CAD), 4.5% (nonobstructive CAD), and 0.1% (no CAD).
- Obstructive and nonobstructive CAD were associated with significantly increased HR (5.4 and 4.2, respectively).
Conclusions:
- CTA is valuable for ruling out future cardiac events in diabetic patients.
- Detecting CAD via CTA identifies high-risk individuals for targeted interventions.
- Aggressive risk factor modification and surveillance in identified patients may improve survival.
Objective:
The usefulness of coronary computed tomography angiography (CTA) for the evaluation of coronary artery disease (CAD) in patients with diabetes is ambiguous. We therefore performed a meta-analysis of studies reporting event rates and hazard ratios (HR) to determine the prognostic value of CTA in this patient population.
Research Design And Methods:
We searched PubMed and Embase up to November 2015. Study subjects' characteristics, events (all-cause mortality or cardiac death, nonfatal myocardial infarction, unstable angina pectoris, stroke, revascularization), and events excluding revascularization were collected. We calculated the prevalence of obstructive and nonobstructive CAD on CTA, annualized event rates, and pooled unadjusted and adjusted HR using a generic inverse random model.
Results:
Eight studies were eligible for inclusion into this meta-analysis, with 6,225 participants (56% male; weighted age, 61 years) with a follow-up period ranging from 20 to 66 months. The prevalence of obstructive CAD, nonobstructive CAD, and no CAD was 38%, 36%, and 25%, respectively. The annualized event rate was 17.1% for obstructive CAD, 4.5% for nonobstructive CAD, and 0.1% for no CAD. Obstructive and nonobstructive CAD were associated with an increased HR of 5.4 and 4.2, respectively. A higher HR for obstructive CAD was observed in studies including revascularization compared with those that did not (7.3 vs. 3.7, P = 0.124).
Conclusions:
CTA in patients with diabetes allows for safely ruling out future events, and the detection of CAD could allow for the identification of high-risk patients in whom aggressive risk factor modification, medical surveillance, or elective revascularization could potentially improve survival.
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