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Published on: August 28, 2018
Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment
Shinichi Wada1, Yoshitaka Iwanaga2, Michikazu Nakai3
1Department of Medical and Health Information Management, National Cerebral and Cardiovascular Center, Suita, Japan; Department of Neurology, Kansai Electric Power Hospital, Osaka, Japan.
Insights
Stepwise cardiovascular risk assessment using coronary artery calcification, stenosis, and FFRct improves prediction of major adverse cardiovascular events in diabetic patients.
Area of Science:
- Cardiology
- Medical Imaging
- Risk Stratification
Background:
- Diabetic Mellitus (DM) and Coronary Artery Disease (CAD) are significant health concerns.
- Accurate risk stratification for cardiovascular events in DM patients with suspected CAD is crucial.
Purpose of the Study:
- To evaluate a stepwise risk stratification approach for predicting Major Adverse Cardiovascular Events (MACE) in patients with DM and suspected CAD.
- To compare the predictive value of coronary artery calcification (CAC), coronary artery stenosis (CAS), and fractional flow reserve CT (FFRct) analysis.
Main Methods:
- A prospective cohort study included 1187 patients with suspected CAD.
- Patients underwent stepwise evaluation including CAC, CAS, and FFRct analysis.
- Cox Proportional Hazards models were used to calculate Hazard Ratios (HR) and 95% Confidence Intervals (CI), adjusting for Framingham risk score.
Main Results:
- MACE occurred more frequently in DM patients (15.9%) compared to non-DM patients (5.7%) over a median follow-up of 4.0 years.
- Lower CAC thresholds (>0 or >50 Agatston score) significantly increased MACE risk in DM patients.
- DM patients with >50 CAC, CAS, and ≤0.71 FFRct had a significantly higher MACE risk (HR 9.84) compared to those with ≤50 CAC.
Conclusions:
- Stepwise assessment integrating CAC, CAS, and FFRct provides enhanced cardiovascular risk stratification for diabetic patients with suspected CAD.
- This multi-imaging approach offers more accurate prediction of MACE beyond traditional clinical risk factors.
Background:
We aimed to examine the stepwise risk stratification for predicting major adverse cardiovascular events (MACE) in patients with DM and suspected coronary artery disease (CAD).
Method:
1187 patients with suspected CAD enrolled in a prospective cohort study were examined. The patients were evaluated step-by-step with coronary artery calcification (CAC), coronary artery stenosis (CAS), and FFRCT analysis. Hazard ratio (HR) and 95 % confidence interval (CI) for incidence MACE were calculated by Cox Proportional Hazards model for adjustment of Framingham risk score.
Results:
During a median follow-up of 4.0 years, MACE frequently occurred in DM patients than non-DM (15.9 % vs. 5.7 %). A lower CAC threshold with >0 or > 50 Agatston score was significantly associated with increased MACE in DM (HR [95 % CI], 3.62 [1.12-11.67] or 4.72 [2.11-10.55], respectively), but not in non-DM. DM patients with >50 CAC, CAS, and ≤ 0.71 FFRCT value showed the HR (95 % CI) for MACE was 9.84 (4.26-22.69) as compared with those with ≤50 CAC, whereas non-DM patients showed that it was 2.56 (1.02-6.43).
Conclusion:
Step-by-step assessment using CAC, CAS, and FFRCT on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.
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