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Coronary computed tomography angiography as a tool for long-term cardiovascular risk stratification in diabetic patients

  • Tom FinckEmail author
  • Albrecht Will
  • Eva Hendrich
  • Stefan Martinoff
  • Martin Hadamitzky
Original Article

Abstract

Objectives of the study were to examine the long-term prognostic power of coronary computed tomography angiography (CCTA) to predict death or myocardial infarction in patients with diabetes mellitus (DM). The prognostic value of CCTA in diabetic patients has been confirmed for short- and intermediate follow-up durations. The slowly progressing nature of coronary artery disease (CAD), however, underlines the necessity to validate CCTA for longer observation periods in this high-risk population. A total of 132 patients with DM and 1781 without DM were examined by CCTA and followed for a median duration of 9.7 (IQR 6.9, 11.2) and 9.9 (IQR 6.9, 11.1) years, respectively. Cox proportional hazards analysis was used for the composite endpoint of death and myocardial infarction. Warranty period was defined as the number of years that an individual stays in a low-risk group with a cumulative probability for the endpoint below 1% and calculated for patients with/without DM and rising degrees of CAD. The study endpoint was reached in 12 (9.1%) patients with and 87 (4.9%) patients without DM (p = 0.024). Quantification of coronary stenosis by CADRADS or CAD severity (normal/non-obstructive/obstructive) was incremental for endpoint prediction with a multivariate (+Morise) χ2 of 3.90 and 3.85, respectively. The lowest annual event rate of 0.19% was noted in non-diabetic patients with no CAD, translating to a warranty period of 5.26 years. The highest annual event rate of 1.73% was found in diabetic patients with obstructive CAD, corresponding to a warranty period of 0.58 years. Compared to patients with no DM and no CAD, the risk of death or myocardial infarction in diabetic patients increased with rising levels of coronary obstruction at multivariate hazard ratios (HR) of 3.28 [95% CI 2.32, 4.64 (p < 0.001)], 3.02 [95% CI 2.19, 4.17 (p < 0.001)] and 9.40 [95% CI 4.90, 18.03 (p < 0.001)] for normal coronary arteries, non-obstructive CAD and obstructive CAD. This study validates the long-term prognostic utility of CCTA-assessed CAD for predicting death or myocardial infarction in a population of patients with DM. The rates of death or myocardial infarction rise with CAD severity in diabetic and non-diabetic patients, identifying the highest risk group of patients with DM and obstructive CAD.

Keywords

Diabetes mellitus Coronary computed tomography angiography Coronary artery disease Prognosis 

Abbreviations

DM

Diabetes mellitus

CAD

Coronary artery disease

CCTA

Coronary computed tomography angiography

SIS

Segment involvement score

CADRADS

Coronary Artery Disease-Reporting and Data System™

ROC

Receiver operator characteristics

SC

Spotty calcification

GC

Gross calcification

Notes

Compliance with ethical standards

Conflicts of interest

The authors have no conflicts of interest to disclose.

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Copyright information

© Springer Japan KK, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Institut für Radiologie und NuklearmedizinDeutsches Herzzentrum München, Klinik an der Technischen Universität MünchenMünchenGermany

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