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Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus.
JACC Cardiovasc Imaging. 2016 11; 9(11):1280-1288.JC

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.

Authors+Show Affiliations

Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Department of Medicine, University of Erlangen, Erlangen, Germany.Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California.Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.William Beaumont Hospital, Royal Oaks, Michigan.Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.Capitol Cardiology Associates, Albany, New York.Department of Medicine, Walter Reed Medical Center, Washington, D.C.Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.University Hospital, Zurich, Switzerland.Baptist Cardiac and Vascular Institute, Miami, Florida.Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.Seoul National University Hospital, Seoul, South Korea.Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.William Beaumont Hospital, Royal Oaks, Michigan.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada.Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca.

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

27568114

Citation

Blanke, Philipp, et al. "Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus." JACC. Cardiovascular Imaging, vol. 9, no. 11, 2016, pp. 1280-1288.
Blanke P, Naoum C, Ahmadi A, et al. Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc Imaging. 2016;9(11):1280-1288.
Blanke, P., Naoum, C., Ahmadi, A., Cheruvu, C., Soon, J., Arepalli, C., Gransar, H., Achenbach, S., Berman, D. S., Budoff, M. J., Callister, T. Q., Al-Mallah, M. H., Cademartiri, F., Chinnaiyan, K., Rubinshtein, R., Marquez, H., DeLago, A., Villines, T. C., Hadamitzky, M., ... Leipsic, J. (2016). Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC. Cardiovascular Imaging, 9(11), 1280-1288. https://doi.org/10.1016/j.jcmg.2015.12.027
Blanke P, et al. Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. JACC Cardiovasc Imaging. 2016;9(11):1280-1288. PubMed PMID: 27568114.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus. AU - Blanke,Philipp, AU - Naoum,Christopher, AU - Ahmadi,Amir, AU - Cheruvu,Chaitu, AU - Soon,Jeanette, AU - Arepalli,Chesnal, AU - Gransar,Heidi, AU - Achenbach,Stephan, AU - Berman,Daniel S, AU - Budoff,Matthew J, AU - Callister,Tracy Q, AU - Al-Mallah,Mouaz H, AU - Cademartiri,Filippo, AU - Chinnaiyan,Kavitha, AU - Rubinshtein,Ronen, AU - Marquez,Hugo, AU - DeLago,Augustin, AU - Villines,Todd C, AU - Hadamitzky,Martin, AU - Hausleiter,Joerg, AU - Shaw,Leslee J, AU - Kaufmann,Philipp A, AU - Cury,Ricardo C, AU - Feuchtner,Gudrun, AU - Kim,Yong-Jin, AU - Maffei,Erica, AU - Raff,Gilbert, AU - Pontone,Gianluca, AU - Andreini,Daniele, AU - Chang,Hyuk-Jae, AU - Chow,Benjamin W, AU - Min,James, AU - Leipsic,Jonathon, Y1 - 2016/08/24/ PY - 2015/10/05/received PY - 2015/12/22/revised PY - 2015/12/30/accepted PY - 2016/8/29/pubmed PY - 2017/10/25/medline PY - 2016/8/29/entrez KW - coronary CT angiography KW - diabetes mellitus KW - prognosis SP - 1280 EP - 1288 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 9 IS - 11 N2 - 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. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/27568114/Long_Term_Prognostic_Utility_of_Coronary_CT_Angiography_in_Stable_Patients_With_Diabetes_Mellitus_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(16)30473-9 DB - PRIME DP - Unbound Medicine ER -