Differences in prevalence, extent, severity, and prognosis of coronary artery disease among patients with and without diabetes undergoing coronary computed tomography angiography: results from 10,110 individuals from the CONFIRM (COronary CT Angiography EvaluatioN For Clinical Outcomes): an InteRnational Multicenter Registry.
OBJECTIVE
We examined the prevalence, extent, severity, and prognosis of coronary artery disease (CAD) in individuals with and without diabetes (DM) who are similar in CAD risk factors.


METHODS
We identified 23,643 consecutive individuals without known CAD undergoing coronary computed tomography angiography. A total of 3,370 DM individuals were propensity matched in a 1-to-2 fashion to 6,740 unique non-DM individuals. CAD was defined as none, nonobstructive (1-49% stenosis), or obstructive (≥ 50% stenosis). All-cause mortality was assessed by risk-adjusted Cox proportional hazards models.


RESULTS
At a 2.2-year follow-up, 108 (3.2%) and 115 (1.7%) deaths occurred among DM and non-DM individuals, respectively. Compared with non-DM individuals, DM individuals possessed higher rates of obstructive CAD (37 vs. 27%) and lower rates of having normal arteries (28 vs. 36%) (P < 0.0001). CAD extent was higher for DM versus non-DM individuals for obstructive one-vessel disease (19 vs. 14%), two-vessel disease (9 vs. 7%), and three-vessel disease (9 vs. 5%) (P < 0.0001 for comparison), with higher per-segment stenosis in the proximal and mid-segments of every coronary artery (P < 0.001 for all). Compared with non-DM individuals with no CAD, risk of mortality for DM individuals was higher for those with no CAD (hazard ratio 3.63 [95% CI 1.67-7.91]; P = 0.001), nonobstructive CAD (5.25 [2.56-10.8]; P < 0.001), one-vessel disease (6.39 [2.98-13.7]; P < 0.0001), two-vessel disease (12.33 [5.622-27.1]; P < 0.0001), and three-vessel disease (13.25 [6.15-28.6]; P < 0.0001).


CONCLUSIONS
Compared with matched non-DM individuals, DM individuals possess higher prevalence, extent, and severity of CAD. At comparable levels of CAD, DM individuals experience higher risk of mortality compared with non-DM individuals.
Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Jamal S
JS
Rana
Allison
A
Dunning
Stephan
S
Achenbach
Mouaz
M
Al-Mallah
Matthew J
MJ
Budoff
Filippo
F
Cademartiri
Tracy Q
TQ
Callister
Hyuk-Jae
HJ
Chang
Victor Y
VY
Cheng
Kavitha
K
Chinnaiyan
Benjamin J W
BJ
Chow
Ricardo
R
Cury
Augustin
A
Delago
Gudrun
G
Feuchtner
Martin
M
Hadamitzky
Jörg
J
Hausleiter
Philipp
P
Kaufmann
Ronald P
RP
Karlsberg
Yong-Jin
YJ
Kim
Jonathon
J
Leipsic
Troy M
TM
Labounty
Fay Y
FY
Lin
Erica
E
Maffei
Gilbert
G
Raff
Todd C
TC
Villines
Leslee J
LJ
Shaw
Daniel S
DS
Berman
James K
JK
Min
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000453:epidemiology* / Q000473:pathology*; D003920:Diabetes Mellitus / Q000503:physiopathology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis