title: Coronary artery disease in patients with atypical chest pain with and without diabetes mellitus assessed with coronary CT angiography.
abstract: BACKGROUND
  Coronary artery disease (CAD) in diabetes mellitus (DM) is often widespread when diagnosed. Non-invasive coronary calcium scoring and coronary CT angiography (CAC-score/CCTA) are accurate in the detection of CAD. This study compared CAD characteristics as identified by CCTA between patients with and without DM with atypical chest pain.
  
  
  METHODS
  CAD was defined as CAC-score >0 and/or presence of coronary plaque. Several CAD characteristics (number of affected segments, obstructive (>50% stenosis) CAD and CAD distribution) were compared on a per patient and segment basis. Subanalysis of duration of DM (<5 or >5 years) and gender was performed.
  
  
  RESULTS
  A total of 1148 patients (63.3% men, mean age 57.7±10.7), of whom 99 (8.6%) suffered from DM, were referred for CCTA. There was no difference in the prevalence of CAD between patients with and without DM (53.5% vs 50.9%, p=0.674). However patients with DM showed more affected coronary segments compared with patients without DM (2.5±3.4 vs 1.7±2.4, p=0.003). Multivariate analysis indicated that DM was an independent predictor of obstructive CAD (OR 2.16, 95% CI 1.23 to 3.78), as were age, women, and Diamond-Forrester score. In our study, obstructive CAD was more prevalent in women than in men (DM 40.0% vs 14.1%, p=0.003; non-DM 16.8% vs 8.4%, p<0.001). Patients suffering from DM >5 years showed more distal plaques (11.2% vs 7.7%, p=0.030).
  
  
  CONCLUSIONS
  Patients with atypical chest pain and DM showed more extensive CAD, as well as more obstructive CAD, particularly in women. Diabetes duration (>5 years) was not associated with more obstructive coronary disease or different plaque morphology, although more distal disease was present.
authors.affiliation: Department of Cardiology , Medical Center Alkmaar , Alkmaar , The Netherlands.
authors.forename: Marije M G
authors.initials: MM
authors.lastname: Krul
authors.affiliation: Department of Cardiology , Rijnland Hospital , Leiderdorp , The Netherlands.
authors.forename: Kjell
authors.initials: K
authors.lastname: Bogaard
authors.affiliation: Department of Nuclear Medicine , Medical Center Alkmaar , Alkmaar , The Netherlands.
authors.forename: Remco J J
authors.initials: RJ
authors.lastname: Knol
authors.affiliation: Department of Cardiology , VU Medical Center , Amsterdam , The Netherlands.
authors.forename: Albert C
authors.initials: AC
authors.lastname: van Rossum
authors.affiliation: Department of Cardiology , VU Medical Center , Amsterdam , The Netherlands.
authors.forename: Paul
authors.initials: P
authors.lastname: Knaapen
authors.affiliation: Department of Cardiology , Medical Center Alkmaar , Alkmaar , The Netherlands.
authors.forename: Jan H
authors.initials: JH
authors.lastname: Cornel
authors.affiliation: Department of Nuclear Medicine , Medical Center Alkmaar , Alkmaar , The Netherlands.
authors.forename: Friso M
authors.initials: FM
authors.lastname: van der Zant
keywords: Coronary Artery; Coronary Artery Disease