Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus

Journal article


Publication Details

Author(s): Blanke P, Naoum C, Ahmadi A, Cheruvu C, Soon J, Arepalli C, Gransar H, Achenbach S, Berman DS, Budoff MJ, Callister TQ, Al-Mallah MH, Cademartiri F, Chinnaiyan K, Rubinshtein R, Marquez H, Delago A, Villines TC, Hadamitzky M, Hausleiter J, Shaw LJ, Kaufmann PA, Cury RC, Feuchtner G, Kim YJ, Maffei E, Raff G, Pontone G, Andreini D, Chang HJ, Chow BW, Min J, Leipsic J
Journal: Journal of the American College of Cardiology : Cardiovascular imaging
Publication year: 2016
Volume: 9
Journal issue: 11
Pages range: 1280-1288
ISSN: 1936-878X
eISSN: 1876-7591


Abstract

OBJECTIVES: The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects.
BACKGROUND: The long-term prognostic value of coronary CTA in patients with DM is not well established.
METHODS: Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models.
RESULTS: A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001).
CONCLUSIONS: Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects.


FAU Authors / FAU Editors

Achenbach, Stephan Prof. Dr. med.
Lehrstuhl für Innere Medizin II


External institutions with authors

Baptist Health South Florida
Beaumont Health System
Capitol Cardiology Associates
Casa di Cura Giovanni XXIII
Cedars-Sinai Medical Center
Deutsches Herzzentrum München
Emory University
Harbor–UCLA Medical Center
Hospital Curry Cabral
Icahn School of Medicine at Mount Sinai
Ludwig-Maximilians-Universität (LMU)
Medizinische Universität Innsbruck
New York Presbyterian Hospital
Seoul National University (SNU) / 서울대학교
Technion - Israel Institute of Technology
Tennessee Heart & Vascular
Università degli studi di Milano
Universitätsspital Zürich (USZ)
University of British Columbia
University of Ottawa
Walter Reed Army Medical Center (WRAMC)
Wayne State University (WSU)
Yonsei University


How to cite

APA:
Blanke, P., Naoum, C., Ahmadi, A., Cheruvu, C., Soon, J., Arepalli, C.,... Leipsic, J. (2016). Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. Journal of the American College of Cardiology : Cardiovascular imaging, 9(11), 1280-1288. https://dx.doi.org/10.1016/j.jcmg.2015.12.027

MLA:
Blanke, Philipp, et al. "Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus." Journal of the American College of Cardiology : Cardiovascular imaging 9.11 (2016): 1280-1288.

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Last updated on 2018-07-11 at 08:53