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Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients



As one of the most frequent risk factors for cardiovascular disease, type 2 diabetes mellitus (T2DM) is one of the largest causes of death. However, an acute cardiac presentation is not uncommon in diabetic patients, and the current investigative approach remains often inadequate. The aim of our study was to retrospectively stratify the risk of asymptomatic T2DM patients using low-dose 640-slice coronary computed tomography angiography (CCTA).

Materials and methods

CCTA examinations of 62 patients (mean age, 65 years) with previous diagnosis of type 2 diabetes and without cardiac symptoms were analyzed. Image acquisition was performed using a 640-slice CT. Per-patient, per-vessel and per-plaque analyses were performed. Stratification risk was evaluated according to the ESC guidelines. The patients were followed up after 2.21 ± 0.56 years from CCTA examination.


Coronary artery disease (CAD) was found in 58 patients (93.55%) presenting 290 plaques. Analysis of all samples showed severe-to-occlusive atherosclerosis in 24 patients (38.7% of cases). However, over the degree of stenosis, 23 patients were evaluated at high risk considering the extension of CAD. Good agreement was shown by the correlation of CAD extension/risk estimation and MACE incidence, according to a Kaplan–Meier survival analysis (p value = 0.001), with a 7.25-fold increased risk (HR 7.25 CI 2.13–24.7; p value = 0.002).


Our study confirms the high capability of CCTA to properly stratify the CV risk of asymptomatic T2DM patients. Its use could be recommended if we consider how current investigative strategies to correctly assess these patients often seem inadequate.

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Type 2 diabetes mellitus


Coronary artery disease


Coronary computed tomography angiography


Major adverse cardiac events


Chronic heart failure


Percutaneous coronary intervention




Automatic exposure control


Standard deviation


Field of view


Dose length product


Multiplanar reconstruction


Maximum intensity projection


Volume rendering


American Heart Association


Hounsfield unit


European Society of Cardiology


Calcium score


Analysis of variance


Left main artery


Left descending artery


Circumflex artery


Right coronary artery


Invasive coronary angiography


Optimal medical therapy


Coronary artery bypass grafting


Hazard ratio




Positron emission tomography


Cardiac magnetic resonance


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The authors wish to thank Angela Martella for the English revision manuscript.


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Correspondence to Pierpaolo Palumbo.

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Our retrospective study was carried out after approval obtained by the internal review board committee of our university.

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All patients provided written informed consent.

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Palumbo, P., Cannizzaro, E., Bruno, F. et al. Coronary artery disease (CAD) extension-derived risk stratification for asymptomatic diabetic patients: usefulness of low-dose coronary computed tomography angiography (CCTA) in detecting high-risk profile patients. Radiol med 125, 1249–1259 (2020).

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  • Type-2 diabetes mellitus
  • Asymptomatic
  • Low-dose
  • CCTA
  • Risk stratification