Prognostic Value of Coronary CT Angiography Among Patients With and Without Diabetes: The Mass General Brigham CCTA registry
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Published on: August 28, 2018
Arthur Shiyovich1, Daniel M Huck1, Rhanderson Cardoso1
1Heart and Vascular Institute, Brigham and Women's Hospital, Mass General Brigham,Harvard Medical School, Boston, Massachusetts, USA.
Insights
Coronary artery disease (CAD) detected by coronary CT angiography is more frequent and severe in patients with diabetes mellitus (DM). The risk of cardiovascular death or myocardial infarction approximately doubles with increasing CAD severity in diabetic patients.
Area of Science:
- Cardiology
- Medical Imaging
- Diabetes Mellitus Research
Background:
- Assessing the link between coronary artery disease (CAD) identified via coronary CT angiography (CCTA) and long-term cardiovascular outcomes.
- Comparing outcomes in patients with and without diabetes mellitus (DM).
Purpose of the Study:
- To evaluate the relationship between CCTA-detected CAD and cardiovascular events.
- To determine if diabetes status modifies this relationship.
Main Methods:
- Retrospective cohort study of 22,377 patients undergoing CCTA.
- Exclusion criteria included prior CAD, advanced kidney disease, or malignancy.
- CAD severity categorized as none, nonobstructive (1-49%), or obstructive (≥50% stenosis).
- Primary outcome: composite of cardiovascular death or myocardial infarction.
Main Results:
- Diabetes was present in 14.5% of patients, who were older with more risk factors.
- Obstructive CAD was more common in patients with diabetes (33% vs. 19%).
- The primary outcome occurred more than twice as often in patients with diabetes (7.8% vs. 3.1%).
- CAD severity independently predicted outcomes, with higher event rates in diabetic patients across all CAD categories.
- Adjusted analysis confirmed obstructive CAD significantly associated with adverse outcomes in both DM and non-DM groups.
Conclusions:
- Coronary artery disease is more prevalent and severe in patients with diabetes undergoing CCTA.
- Cardiovascular death or myocardial infarction risk escalates with CAD severity.
- Diabetes approximately doubles the risk of cardiovascular events for any given CAD severity.
Background:
This study aimed to assess the relationship between coronary CT angiography detected coronary artery disease (CAD) and long-term cardiovascular outcomes among individuals with and without diabetes mellitus (DM).
Methods:
A retrospective cohort study of patients undergoing CCTA at two medical centers between 2006 and 2024. Patients with prior CAD, advanced kidney disease, or malignancy were excluded. DM was defined by diagnostic codes or elevated hemoglobin A1c. CCTA findings were categorized as no CAD, nonobstructive CAD (1-49% stenosis), or obstructive CAD (≥ 50% stenosis). The primary outcome was a composite of cardiovascular death (CVD) or myocardial infarction (MI).
Results:
Among 22,377 patients (median age 56 [IQR 47-65]; 45% women), 3,245 (14.5%) had diabetes. Individuals with diabetes were older and had more cardiovascular risk factors. Obstructive CAD was more frequent in patients with diabetes (33% vs. 19%), whereas no CAD was less common (23% vs. 42%). Over a median follow-up of 6 years (IQR 3.9-9.5), the primary outcome occurred more than twice as often among those with diabetes (7.8% vs. 3.1%; P < 0.001). Event rates increased with CAD severity and remained higher among individuals with diabetes across all categories. After adjustment, obstructive CAD remained significantly associated with the primary outcome in both groups (DM: HR 2.9 [95% CI 1.8-4.6], P < 0.001; non-DM: HR 2.7 [95% CI 2.1-3.4]), p < 0.001).
Conclusions:
Among patients undergoing CCTA, CAD was more frequent and severe in those with diabetes, and the risk of CVD or MI increased with CAD severity, approximately doubling in each category when diabetes was present.
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