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Prognostic value of coronary computed tomographic angiography in diabetic patients without known coronary artery disease.

Hadamitzky M, Hein F, Meyer T, Bischoff B, Martinoff S, Schömig A, Hausleiter J - Diabetes Care (2010)

Bottom Line: The best predictor in diabetic patients was the atherosclerotic burden score: the annual event rate ranged from 0.5% for patients with <5 lesions to 9.6% for patients with >9 lesions, resulting in a hazard ratio (HR) of 1.3 (95% CI 1.1-1.7) for each additional lesion (P = 0.005).For comparison, in nondiabetic patients the annual event rate ranged from 0.3 to 2.2%, respectively, resulting in an HR of 1.2 (95% CI 1.1-1.3, P < 0.001).The atherosclerotic burden score improved the prognostic value of conventional risk factors significantly (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Hospital at the Technische Universität München, Munich, Germany. mhy@dhm.mhn.de

ABSTRACT

Objective: Diabetic patients have a high prevalence of coronary artery disease (CAD), but timely diagnosis of CAD remains challenging. We assessed the ability of coronary computed tomography angiography (CCTA) to detect CAD in diabetic patients and to predict subsequent cardiac events.

Research design and methods: We analyzed 140 diabetic patients without known CAD undergoing CCTA; 1,782 patients without diabetes were used as a control group. Besides calcium scoring and the degree of the most severe stenosis, the atherosclerotic burden score counting the number of segments having either a nonstenotic plaque or a stenosis was recorded. The primary end point was a composite of hard cardiac events defined as all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization.

Results: During a mean follow-up of 33 months, there were seven events in the diabetic group and 24 events in the control group. The best predictor in diabetic patients was the atherosclerotic burden score: the annual event rate ranged from 0.5% for patients with <5 lesions to 9.6% for patients with >9 lesions, resulting in a hazard ratio (HR) of 1.3 (95% CI 1.1-1.7) for each additional lesion (P = 0.005). For comparison, in nondiabetic patients the annual event rate ranged from 0.3 to 2.2%, respectively, resulting in an HR of 1.2 (95% CI 1.1-1.3, P < 0.001). The atherosclerotic burden score improved the prognostic value of conventional risk factors significantly (P < 0.001).

Conclusions: In diabetic patients without known CAD, CCTA can identify a patient group at particularly high risk for subsequent hard cardiac events.

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Related in: MedlinePlus

Survival free of hard cardiac events in correlation with the atherosclerosis burden score, counting the number of lesions having either nonstenotic plaques or stenoses (irrespective of degree), in patients both with and without diabetes. The numbers of patients at risk refer to the three groups analyzed (top <5, middle 5–9, and bottom >9 diseased segments).
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Figure 1: Survival free of hard cardiac events in correlation with the atherosclerosis burden score, counting the number of lesions having either nonstenotic plaques or stenoses (irrespective of degree), in patients both with and without diabetes. The numbers of patients at risk refer to the three groups analyzed (top <5, middle 5–9, and bottom >9 diseased segments).

Mentions: The primary end point correlated best with the atherosclerotic burden score in CCTA both in diabetic and nondiabetic patients. In diabetic patients, the annual event rate ranged from 0.5% (95% CI 0.1–3.8%) in patients with <5 lesions to 9.6% (4.0–23.1%) for patients with >9 lesions, resulting in an HR of 1.3 (1.1–1.7, P = 0.005) for each additional lesion. For comparison, in nondiabetic patients the annual event rate increased from 0.3% (0.1–0.6%) for patient with <5 lesions to 2.2% (0.9–5.4%) for patients with >9 lesions. The HR was 1.2 (1.1–1.3, P < 0.001) (Fig. 1).


Prognostic value of coronary computed tomographic angiography in diabetic patients without known coronary artery disease.

Hadamitzky M, Hein F, Meyer T, Bischoff B, Martinoff S, Schömig A, Hausleiter J - Diabetes Care (2010)

Survival free of hard cardiac events in correlation with the atherosclerosis burden score, counting the number of lesions having either nonstenotic plaques or stenoses (irrespective of degree), in patients both with and without diabetes. The numbers of patients at risk refer to the three groups analyzed (top <5, middle 5–9, and bottom >9 diseased segments).
© Copyright Policy - creative-commons
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2875454&req=5

Figure 1: Survival free of hard cardiac events in correlation with the atherosclerosis burden score, counting the number of lesions having either nonstenotic plaques or stenoses (irrespective of degree), in patients both with and without diabetes. The numbers of patients at risk refer to the three groups analyzed (top <5, middle 5–9, and bottom >9 diseased segments).
Mentions: The primary end point correlated best with the atherosclerotic burden score in CCTA both in diabetic and nondiabetic patients. In diabetic patients, the annual event rate ranged from 0.5% (95% CI 0.1–3.8%) in patients with <5 lesions to 9.6% (4.0–23.1%) for patients with >9 lesions, resulting in an HR of 1.3 (1.1–1.7, P = 0.005) for each additional lesion. For comparison, in nondiabetic patients the annual event rate increased from 0.3% (0.1–0.6%) for patient with <5 lesions to 2.2% (0.9–5.4%) for patients with >9 lesions. The HR was 1.2 (1.1–1.3, P < 0.001) (Fig. 1).

Bottom Line: The best predictor in diabetic patients was the atherosclerotic burden score: the annual event rate ranged from 0.5% for patients with <5 lesions to 9.6% for patients with >9 lesions, resulting in a hazard ratio (HR) of 1.3 (95% CI 1.1-1.7) for each additional lesion (P = 0.005).For comparison, in nondiabetic patients the annual event rate ranged from 0.3 to 2.2%, respectively, resulting in an HR of 1.2 (95% CI 1.1-1.3, P < 0.001).The atherosclerotic burden score improved the prognostic value of conventional risk factors significantly (P < 0.001).

View Article: PubMed Central - PubMed

Affiliation: Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Hospital at the Technische Universität München, Munich, Germany. mhy@dhm.mhn.de

ABSTRACT

Objective: Diabetic patients have a high prevalence of coronary artery disease (CAD), but timely diagnosis of CAD remains challenging. We assessed the ability of coronary computed tomography angiography (CCTA) to detect CAD in diabetic patients and to predict subsequent cardiac events.

Research design and methods: We analyzed 140 diabetic patients without known CAD undergoing CCTA; 1,782 patients without diabetes were used as a control group. Besides calcium scoring and the degree of the most severe stenosis, the atherosclerotic burden score counting the number of segments having either a nonstenotic plaque or a stenosis was recorded. The primary end point was a composite of hard cardiac events defined as all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization.

Results: During a mean follow-up of 33 months, there were seven events in the diabetic group and 24 events in the control group. The best predictor in diabetic patients was the atherosclerotic burden score: the annual event rate ranged from 0.5% for patients with <5 lesions to 9.6% for patients with >9 lesions, resulting in a hazard ratio (HR) of 1.3 (95% CI 1.1-1.7) for each additional lesion (P = 0.005). For comparison, in nondiabetic patients the annual event rate ranged from 0.3 to 2.2%, respectively, resulting in an HR of 1.2 (95% CI 1.1-1.3, P < 0.001). The atherosclerotic burden score improved the prognostic value of conventional risk factors significantly (P < 0.001).

Conclusions: In diabetic patients without known CAD, CCTA can identify a patient group at particularly high risk for subsequent hard cardiac events.

Show MeSH
Related in: MedlinePlus