Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry

Lee J, Shaikh K, Nakanishi R, Gransar H, Achenbach S, Al-Mallah MH, Andreini D, Bax JJ, Berman DS, Cademartiri F, Callister TQ, Chang HJ, Chinnaiyan K, Chow BJ, Cury RC, DeLago A, Feuchtner G, Hadamitzky M, Hausleiter J, Kaufmann PA, Kim YJ, Leipsic JA, Maffei E, Marques H, de Araújo Gonçalves P, Pontone G, Rubinshtein R, Villines TC, Lu Y, Peña JM, Lin FY, Min JK, Shaw LJ, Budoff MJ (2022)

Publication Type: Journal article

Publication year: 2022

Journal

DOI: 10.1016/j.hlc.2022.09.014

Abstract

Background: Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known. Methods: We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry. Cumulative long-term incidence of all-cause mortality (ACM) was assessed between DM and non-DM patients by normal or non-obstructive LM disease (1–49% stenosis). Results: The mean age of the study population was 57.6 ± 12.6 years. Of the 27,252 patients, 4,434 (16%) patients had DM. A total of 899 (3%) deaths occurred during the follow-up of 3.6±1.9. years. Compared to patients with normal LM, those with non-obstructive LM had more pronounced overall coronary atherosclerosis and more cardiovascular risk factors. After clinical risk factors, segment involvement score, and stenosis severity adjustment, compared to patients without DM and normal LM, patients with DM were associated with increased ACM regardless of normal (HR 1.48, 95% CI 1.22–1.78, p<0.001) or non-obstructive LM (HR 1.46, 95% CI 1.04–2.04, p=0.029), while nonobstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85, 95% CI 0.67–1.07, p=0.165) and there was no significant interaction between DM and LM status (HR 1.03, 95% CI 0.69–1.54, p=0.879). Conclusion: From the CONFIRM registry, we demonstrated that DM was associated with increased ACM. However, the presence of non-obstructive LM was not an independent risk marker of ACM, and there was no significant interaction between DM and non-obstructive LM disease for ACM.

Authors with CRIS profile

Involved external institutions

Harbor–UCLA Medical Center United States (USA) (US) Houston Methodist United States (USA) (US) Cedars-Sinai Medical Center United States (USA) (US) Universitätsspital Zürich (USZ) Switzerland (CH) Capitol Cardiology Associates United States (USA) (US) Medizinische Universität Innsbruck Austria (AT) Klinikum der Universität München Germany (DE) Deutsches Herzzentrum München Germany (DE) Seoul National University (SNU) / 서울대학교 Korea, Republic of (KR) University of British Columbia Canada (CA) Cleerly Inc. United States (USA) (US) Weill Cornell Medicine United States (USA) (US) New York Presbyterian Hospital United States (USA) (US) Hospital da Luz Portugal (PT) Consiglio Nazionale delle Ricerche (CNR) / National Research Council of Italy Italy (IT) University of Virginia Health System United States (USA) (US) Centro Cardiologico Monzino (IRCCS) Italy (IT) University of Ottawa Canada (CA) Baptist Health South Florida United States (USA) (US) Leiden University Medical Center Netherlands (NL) Tennessee Heart & Vascular United States (USA) (US) Yonsei University Health System (YUHS) Korea, Republic of (KR) Carmel Medical Center Israel (IL) Beaumont Health United States (USA) (US)

How to cite

APA:

Lee, J., Shaikh, K., Nakanishi, R., Gransar, H., Achenbach, S., Al-Mallah, M.H.,... Budoff, M.J. (2022). Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry. Heart Lung and Circulation. https://dx.doi.org/10.1016/j.hlc.2022.09.014

MLA:

Lee, Juhwan, et al. "Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry." Heart Lung and Circulation (2022).

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