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Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes:

Juhwan Lee1, Kashif Shaikh2, Rine Nakanishi3

  • 1Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA; Department of Medicine, CHA University GUMI CHA Hospital, Gyeongsangbuk-do, South Korea.

Heart, Lung & Circulation
|November 6, 2022
PubMed

Insights

Diabetes mellitus (DM) increases all-cause mortality (ACM) risk, irrespective of non-obstructive left main (LM) disease. Non-obstructive LM disease alone does not independently predict ACM, and its interaction with DM for mortality risk is not significant.

Area of Science:

  • Cardiology
  • Medical Imaging
  • Public Health

Background:

  • The prognostic significance of non-obstructive left main (LM) disease is an emerging area of research.
  • The impact of diabetes mellitus (DM) on cardiovascular event rates in patients with varying degrees of LM disease, particularly non-obstructive disease, remains incompletely understood.

Purpose of the Study:

  • To investigate the independent and interactive effects of diabetes mellitus (DM) and non-obstructive left main (LM) disease on long-term all-cause mortality (ACM).
  • To assess whether non-obstructive LM disease confers an additional mortality risk in patients with or without DM.

Main Methods:

  • Analysis of 27,252 patients from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry.
  • Assessment of cumulative long-term incidence of all-cause mortality (ACM) stratified by DM status and LM disease severity (normal vs. non-obstructive [1-49% stenosis]).
  • Statistical adjustment for clinical risk factors, segment involvement score, and stenosis severity.

Main Results:

  • Diabetes mellitus (DM) was present in 16% of patients; 899 (3%) deaths occurred over a mean follow-up of 3.6 years.
  • Patients with DM exhibited increased ACM compared to those without DM, regardless of normal or non-obstructive LM disease (adjusted HRs 1.48 and 1.46, respectively).
  • Non-obstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85), and no significant interaction was found between DM and LM status for ACM (HR 1.03).

Conclusions:

  • Diabetes mellitus (DM) is a significant independent predictor of increased all-cause mortality (ACM).
  • Non-obstructive left main (LM) disease, defined as 1-49% stenosis, was not identified as an independent risk marker for ACM in this cohort.
  • There was no statistically significant interaction between DM status and the presence of non-obstructive LM disease concerning all-cause mortality.
Abstract

Keywords:
All-cause mortalityCoronary computed tomographic angiographyDiabetes mellitusLeft mainNonobstructive coronary artery disease

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