Prognostic value of CT coronary angiography in diabetic and non-diabetic subjects with suspected CAD: importance of presenting symptoms

Abstract

AimTo assess the prognostic relevance of 64-slice computed tomography coronary angiography (CT-CA) and symptoms in diabetics and non-diabetics referred for cardiac evaluation.MethodsWe followed 210 patients with diabetes type 2 (DM) and 203 non-diabetic patients referred for CT-CA for ruling out coronary artery disease (CAD). Patients were without known history of CAD and were divided into four categories on the basis of symptoms at presentation (none, atypical angina, typical angina and dyspnoea). Clinical end points were major cardiac events (MACE): cardiac-related death, non-fatal myocardial infarction, unstable angina and cardiac revascularizations. Cox proportional hazard models, with and without adjustment for risk factors and multiplicative interaction term (obstructive CAD × DM), were developed to predict outcome.ResultsDM patients with dyspnoea or who were asymptomatic showed a higher prevalence of obstructive CAD than non-diabetics (p ≤ 0.01). At mean follow-up of 20.4 months, DM patients had worse cardiac event-free survival in comparison with non-DM patients (90% vs. 81%, p = 0.02). In multivariate analysis, CT-CA evidence of obstructive CAD (in DM patients: HR: 6.4; 95% CI: 2.3–17.5; p < 0.001; in non-DM patients: HR: 7.4; 95% CI: 2.1–26.7; p = 0.002) and the presence of typical angina (in DM patients: HR: 2.9; 95% CI: 1.3–6.3; p = 0.007; in non-DM patients: HR: 2.7; 95% CI: 1.1–7.1; p = 0.03) were independent predictors of MACE in both groups. Furthermore, other independent outcome predictors included dyspnoea (HR: 3.8; 95% CI: 1.7–8.5; p = 0.001), the number of segments with any CAD (HR: 1.1; 95% CI: 1.001–1.2; p = 0.04) in DM patients and coronary calcium score >100 in non-DM patients (HR: 5.6; 95% CI: 1.4–21.5; p = 0.01). In Cox regression analysis of the overall population, interaction term obstructive CAD × DM resulted in non-significance.ConclusionsAmong DM patients, dyspnoea carried a high event risk with a MACE rate four times higher. CT-CA findings were strongly predictive of outcome and proved valuable for further risk stratification.

Cardiac computed tomography improves prediction of long-term cardiovascular events: a retrospective cohort study of type 2 diabetic with higher cardiovascular risk

“…Despite the heterogeneity between study endpoints, study population, and length of follow-up, previous systematic literature reviews and meta-analyses [19,20] con rmed that the presence and extent of CAD on CCTA are strong, independent predictors of CVEVs in asymptomatic individuals with D2M. In our study, obstructive CAD in patients with D2M were associated with a poor prognosis, which is consistent with the ndings of previous studies [21]. Moreover, ABOS, which represents the involvements of coronary obstructive stenosis, showed the highest OR (14.060) among all risk factors and was an independent predictor of CVEVs.…”

Prognostic Value of Coronary Computed Tomography Angiography in Patients With Diabetes: A Meta-analysis

“…Coronary artery calcium scoring (CACS) has been proposed as a first-line test for CAD in patients with diabetes (30). Only two of the included studies (31,32) assessed the prognostic value of stenosis degree on CTA beyond CACS, and both concluded that CTA provided additional value over CACS. In addition, several other studies confirm the incremental value of CTA.…”

History of severe hypoglycemia in type II diabetes mellitus unmasked significant atherosclerotic coronary artery disease: a matched case-control study

“…The prevalence of signi cant ACAD in the control T2DM patients, 46.4% correlated with previous studies which employed CCTA for detection of signi cant CAD. [28][29] ( Table 2) C. Subgroup analysis within SH group i. Recurrent SH vs single episode of SH There were 5 (18%) patients with recurrent episodes of SH. Comparison between patients with recurrent SH and single episode of SH, showed these patients to be older, and had lower creatinine clearance which might had explained the higher risk of recurrent severe hypoglycemia.…”