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Prognostic Value of Atherosclerotic Extent in Diabetic Patients with Nonobstructive Coronary Artery Disease
Yipu Ding1,2, Zinuan Liu1,2, Guanhua Dou1
1Department of Cardiology, Chinese PLA General Hospital, Beijing 100853, China.
Insights
In patients with diabetes mellitus and nonobstructive coronary artery disease, a higher Leiden score indicated increased risk for major adverse cardiovascular events (MACEs). This highlights the need for improved risk stratification.
Area of Science:
- Cardiology
- Diabetology
- Radiology
Background:
- Coronary artery disease (CAD) is a significant concern in patients with diabetes mellitus (DM).
- Nonobstructive CAD requires effective risk stratification to prevent major adverse cardiovascular events (MACEs).
Purpose of the Study:
- To investigate the prognostic value of atherosclerotic plaque burden, assessed by the Leiden score, in DM patients with nonobstructive coronary artery disease.
- To determine if plaque extent predicts MACEs in this population.
Main Methods:
- 813 DM patients with suspected CAD underwent coronary computed tomography angiography (CCTA).
- Patients were categorized based on coronary stenosis and Leiden score (<5 vs. ≥5).
- Cox models analyzed MACE rates (cardiovascular death, myocardial infarction, unstable angina, stroke) during follow-up.
Main Results:
- An incremental incidence of MACEs was observed with increasing plaque burden.
- DM patients with a Leiden score ≥5 had a significantly higher risk of MACEs compared to those with a Leiden score <5 (HR: 1.88, p=0.039), even after adjusting for risk factors.
- Sensitivity analysis using the segment involvement score (SIS) confirmed these findings.
Conclusions:
- Atherosclerotic extent, quantified by the Leiden score, is significantly associated with prognosis in DM patients with nonobstructive coronary artery disease.
- These findings underscore the importance of comprehensive risk stratification and tailored management strategies for this patient group.
Methods And Results:
813 DM patients (mean age 58.9 ± 9.9 years, 48.1% male) referred for CCTA due to suspected CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 major adverse cardiovascular events (MACEs) (6.15%) were experienced, including 2 cardiovascular deaths, 14 nonfatal myocardial infarctions, 27 unstable anginas requiring hospitalization, and 7 strokes. Three groups were defined based on coronary stenosis combined with Leiden score as normal, nonobstructive Leiden < 5, and nonobstructive Leiden ≥ 5. Cox models were used to assess the prognosis of plaque burden within these groups. An incremental incidence of MACE rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of Leiden ≥ 5 showed a higher risk than Leiden < 5 (HR: 1.88, 95% CI: 1.03-3.42, p = 0.039). Similar results were observed when segment involvement score (SIS) was used for sensitivity analysis.
Conclusion:
Atherosclerotic extent was associated with the prognosis of DM patients with nonobstructive coronary artery disease, highlighting the importance of better risk stratification and management.
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