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Obstructive coronary artery disease in symptomatic diabetics with zero coronary calcium score: are we missing
Francesca Calicchio1, Venkat Sanjay Manubolu, Suraj Dahal
1Division of Cardiology, Lundquist Institute at Harbor UCLA Medical Center, Torrance, California, USA.
Insights
Symptomatic diabetics with a zero coronary artery calcium score can still have significant coronary artery disease (CAD). Coronary computed tomography angiography (CCTA) is crucial for accurate risk stratification in this population.
Area of Science:
- Cardiology
- Radiology
- Diabetes Mellitus
Background:
- Coronary artery disease (CAD) prevalence and severity in symptomatic patients with a zero coronary artery calcium score (CACS) remain unclear.
- Diabetic patients are a high-risk subgroup for cardiovascular events.
- The study focuses on symptomatic diabetic individuals with zero CACS.
Purpose of the Study:
- To investigate the prevalence and severity of CAD using coronary computed tomography angiography (CCTA).
- To assess CAD in a symptomatic diabetic cohort presenting with a zero CACS.
Main Methods:
- Inclusion of consecutive symptomatic diabetic patients with suspected CAD.
- Performance of noncontrast coronary artery calcium scan followed by CCTA.
- Quantification of CACS using the Agatston method and definition of CAD by total plaque score (TPS).
- Definition of obstructive and severe obstructive CAD based on luminal stenosis percentages.
Main Results:
- 1722 symptomatic diabetics were analyzed; 111 had zero CACS but TPS > 0.
- Among those with zero CACS and plaque, CAD prevalence was 100% (111/111).
- Obstructive CAD was identified in 11 subjects (9.9%), with 3 having severe obstructive CAD (2.7%).
- CAD in this zero CACS group was more prevalent in middle-aged adults, women, and Hispanic individuals.
Conclusions:
- Coronary artery disease, including obstructive disease, can be present in symptomatic diabetic patients with a zero CACS.
- CCTA is essential for accurate cardiovascular risk stratification in symptomatic diabetics, even with a zero CACS.
- Findings highlight the importance of CCTA for identifying CAD in specific demographic subgroups within the diabetic population.
Background:
Prevalence and severity of coronary artery disease (CAD) in symptomatic patients with zero coronary artery calcium score (CACS) are unclear, particularly in regard to the diabetic population, which represents, per se, a subgroup at increased cardiovascular risk. The aim of this study was to investigate the prevalence and severity of CAD by coronary computed tomography angiography (CCTA) in a symptomatic diabetic cohort with zero CACS.
Methods:
All consecutive symptomatic diabetics referred for CAD suspicion were included in this study. All subjects underwent a noncontrast coronary artery calcium scan followed by CCTA. CACS was quantified using the Agatston method. CAD was defined as a total plaque score (TPS) greater than zero. Obstructive and severe obstructive CAD were defined respectively as luminal stenosis >50% and >70% in at least one coronary segment.
Results:
We identified 1722 symptomatic diabetics (mean age 62.5 ± 12.9 years, 62% men). One hundred and eleven subjects had zero CACS and TPS >0 (mean age was 49.5 ± 14.8, 58% women, 56% Hispanics). Sixty-five patients (58.5%) had one-vessel disease, followed by 30 (27%) with two-vessel disease and 14 (12.6%) with ≥ three-vessel disease. Obstructive CAD was found in 11 subjects and, among these, three were categorized as severe obstructive CAD.
Conclusion:
In symptomatic diabetic patients with zero CACS, CAD, including obstructive disease, can still occur and is predominant in middle-aged adults, women and Hispanics. In symptomatic diabetics CCTA is a critical step for accurate risk stratification even when CACS would have placed some of these individuals in a lower-risk category.
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