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

• Published in: JACC. Cardiovascular imaging Vol. 9; no. 11; pp. 1280 - 1288
• Main Authors: Blanke, Philipp, MD, Naoum, Christopher, MBBS, Ahmadi, Amir, MD, Cheruvu, Chaitu, MBBS, Soon, Jeanette, MBBS, Arepalli, Chesnal, MD, Gransar, Heidi, PhD, Achenbach, Stephan, MD, Berman, Daniel S., MD, Budoff, Matthew J., MD, Callister, Tracy Q., MD, Al-Mallah, Mouaz H., MD, Cademartiri, Filippo, MD, Chinnaiyan, Kavitha, MD, Rubinshtein, Ronen, MD, Marquez, Hugo, MD, DeLago, Augustin, MD, Villines, Todd C., MD, Hadamitzky, Martin, MD, Hausleiter, Joerg, MD, Shaw, Leslee J., MD, Kaufmann, Philipp A., MD, Cury, Ricardo C., MD, Feuchtner, Gudrun, MD, Kim, Yong-Jin, MD, Maffei, Erica, MD, Raff, Gilbert, MD, Pontone, Gianluca, MD, Andreini, Daniele, MD, Chang, Hyuk-Jae, MD, Chow, Benjamin W., MD, Min, James, MD, Leipsic, Jonathon, MD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Aged; Cardiovascular; Computed Tomography Angiography; Coronary Angiography - methods; Coronary Artery Disease - diagnostic imaging; Coronary Artery Disease - mortality; Coronary Artery Disease - therapy; coronary CT angiography; Coronary Stenosis - diagnostic imaging; Coronary Stenosis - mortality; Coronary Stenosis - therapy; diabetes mellitus; Diabetes Mellitus - diagnosis; Diabetes Mellitus - mortality; Diabetes Mellitus - therapy; Female; Humans; Kaplan-Meier Estimate; Male; Middle Aged; Multidetector Computed Tomography; Multivariate Analysis; Predictive Value of Tests; Prevalence; Prognosis; Propensity Score; Proportional Hazards Models; Prospective Studies; Registries; Risk Factors; Severity of Illness Index; Time Factors; coronary artery disease; coronary CT angiography; LM; CI; CAD; major adverse cardiovascular event(s); computed tomography angiography; DM; diabetes mellitus; HR; left main; prognosis; CTA; MACE; hazard ratio; confidence interval
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2015.12.027

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.