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Published on: August 28, 2018
Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus
Philipp Blanke1, Christopher Naoum1, Amir Ahmadi2
1Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
Insights
Coronary CTA reveals that diabetes patients with any coronary artery disease (CAD) have higher mortality. However, diabetic patients without CAD on CTA have a similar risk to non-diabetic individuals.
Area of Science:
- Cardiology
- Radiology
- Diabetology
Background:
- The long-term prognostic value of coronary computed tomography angiography (CTA) in patients with diabetes mellitus (DM) remains underexplored.
- Establishing the prognostic implications of coronary CTA in diabetic populations is crucial for risk stratification.
Purpose of the Study:
- To assess the long-term prognostic value of coronary CTA in patients with DM compared to nondiabetic subjects.
- To determine if coronary CTA findings modify cardiovascular risk in diabetic patients.
Main Methods:
- Utilized 5-year follow-up data from the CONFIRM registry.
- Analyzed coronary artery disease (CAD) extent and severity via coronary CTA (none, nonobstructive, obstructive).
- Employed multivariable Cox proportional hazards models for time-to-death and major adverse cardiovascular events analysis, using propensity matching for diabetic and nondiabetic cohorts.
Main Results:
- Propensity-matched analysis of 1,823 diabetic and 1,823 nondiabetic patients.
- Diabetic patients with nonobstructive CAD showed a significantly increased mortality risk (HR 2.10) compared to nondiabetic subjects.
- Both nonobstructive and obstructive CAD in diabetic patients increased all-cause mortality risk compared to those without atherosclerosis.
Conclusions:
- In diabetic patients, both nonobstructive and obstructive coronary artery disease (CAD) identified by coronary CTA are linked to increased 5-year mortality and major adverse cardiovascular events.
- Diabetic patients without detectable CAD on coronary CTA had a mortality risk comparable to nondiabetic subjects.
- Coronary CTA effectively stratifies risk in diabetic patients, highlighting that even nonobstructive CAD carries significant prognostic implications.
Objectives:
The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects.
Background:
The long-term prognostic value of coronary CTA in patients with DM is not well established.
Methods:
Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models.
Results:
A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001).
Conclusions:
Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects.
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