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Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis.
J Cardiovasc Comput Tomogr. 2018 Jul - Aug; 12(4):320-328.JC

Abstract

BACKGROUND

Coronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup.

METHODS

We searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression.

RESULTS

A total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063).

CONCLUSION

The presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up.

Authors+Show Affiliations

Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany.Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany. Electronic address: Felix.Meinel@med.uni-rostock.de.Department of Radiology, University Hospital, LMU Munich, Germany.Department of Radiology, University Hospital, LMU Munich, Germany.Department of Radiology, University Hospital, LMU Munich, Germany; Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany.Medizinische Klinik und Poliklinik I, Ludwig Maximilians University, Munich, Germany.Department of Radiology, University of Tübingen, Germany.Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA; Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany; Department of Infectious Diseases & Tropical Medicine, Ludwig-Maximilians University, Germany.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

29685675

Citation

Beller, Ebba, et al. "Predictive Value of Coronary Computed Tomography Angiography in Asymptomatic Individuals With Diabetes Mellitus: Systematic Review and Meta-analysis." Journal of Cardiovascular Computed Tomography, vol. 12, no. 4, 2018, pp. 320-328.
Beller E, Meinel FG, Schoeppe F, et al. Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis. J Cardiovasc Comput Tomogr. 2018;12(4):320-328.
Beller, E., Meinel, F. G., Schoeppe, F., Kunz, W. G., Thierfelder, K. M., Hausleiter, J., Bamberg, F., Schoepf, U. J., & Hoffmann, V. S. (2018). Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis. Journal of Cardiovascular Computed Tomography, 12(4), 320-328. https://doi.org/10.1016/j.jcct.2018.04.002
Beller E, et al. Predictive Value of Coronary Computed Tomography Angiography in Asymptomatic Individuals With Diabetes Mellitus: Systematic Review and Meta-analysis. J Cardiovasc Comput Tomogr. 2018 Jul - Aug;12(4):320-328. PubMed PMID: 29685675.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis. AU - Beller,Ebba, AU - Meinel,Felix G, AU - Schoeppe,Franziska, AU - Kunz,Wolfgang G, AU - Thierfelder,Kolja M, AU - Hausleiter,Jörg, AU - Bamberg,Fabian, AU - Schoepf,U Joseph, AU - Hoffmann,Verena S, Y1 - 2018/04/12/ PY - 2018/01/06/received PY - 2018/03/31/revised PY - 2018/04/08/accepted PY - 2018/4/25/pubmed PY - 2018/11/6/medline PY - 2018/4/25/entrez KW - Asymptomatic KW - Computed tomography KW - Coronary artery disease KW - Diabetes mellitus KW - Screening SP - 320 EP - 328 JF - Journal of cardiovascular computed tomography JO - J Cardiovasc Comput Tomogr VL - 12 IS - 4 N2 - BACKGROUND: Coronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup. METHODS: We searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression. RESULTS: A total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063). CONCLUSION: The presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up. SN - 1876-861X UR - https://www.unboundmedicine.com/medline/citation/29685675/Predictive_value_of_coronary_computed_tomography_angiography_in_asymptomatic_individuals_with_diabetes_mellitus:_Systematic_review_and_meta_analysis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1934-5925(18)30065-0 DB - PRIME DP - Unbound Medicine ER -