title: Prognostic value of coronary computed tomography angiography in diabetic patients without chest pain syndrome.
abstract: OBJECTIVE
  Diabetic patients with coronary artery disease (CAD) are often free of chest pain syndrome. A useful modality for non-invasive assessment of CAD is coronary computed tomography angiography (CTA). However, the prognostic value of CAD on coronary CTA in diabetic patients without chest pain syndrome is relatively unknown. Therefore, the aim was to investigate the long-term prognostic value of coronary CTA in a large population diabetic patients without chest pain syndrome.
  
  
  METHODS
  Between 2005 and 2013, 525 diabetic patients without chest pain syndrome were prospectively included to undergo coronary artery calcium (CAC)-scoring followed by coronary CTA. During follow-up, the composite endpoint of all-cause mortality, non-fatal myocardial infarction (MI), and late revascularization (>90 days) was registered.
  
  
  RESULTS
  In total, CAC-scoring was performed in 410 patients and coronary CTA in 444 patients (431 interpretable). After median follow-up of 5.0 (IQR 2.7-6.5) years, the composite endpoint occurred in 65 (14%) patients. Coronary CTA demonstrated a high prevalence of CAD (85%), mostly non-obstructive CAD (51%). Furthermore, patients with a normal CTA had an excellent prognosis (event-rate 3%). An incremental increase in event-rate was observed with increasing CAC-risk category or coronary stenosis severity. Finally, obstructive (50-70%) or severe CAD (>70%) was independently predictive of events (HR 11.10 [2.52;48.79] (P = .001), HR 15.16 [3.01;76.36] (P = .001)). Obstructive (50-70%) or severe CAD (>70%) provided increased value over baseline risk factors.
  
  
  CONCLUSIONS
  Coronary CTA provided prognostic value in diabetic patients without chest pain syndrome. Most importantly, the prognosis of patients with a normal CTA was excellent.
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
authors.forename: Inge J
authors.initials: IJ
authors.lastname: van den Hoogen
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. M.A.de_Graaf@lumc.nl.|The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands. M.A.de_Graaf@lumc.nl.
authors.forename: Michiel A
authors.initials: MA
authors.lastname: de Graaf
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.|The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: Cornelis J
authors.initials: CJ
authors.lastname: Roos
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
authors.forename: Aukelien C
authors.initials: AC
authors.lastname: Leen
authors.affiliation: Department of Internal Medicine, Westeinde Hospital, The Hague, The Netherlands.
authors.forename: Aan V
authors.initials: AV
authors.lastname: Kharagjitsingh
authors.affiliation: Department of Medical Statistics and Bio-informatics, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Ron
authors.initials: R
authors.lastname: Wolterbeek
authors.affiliation: Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands.
authors.forename: Lucia J
authors.initials: LJ
authors.lastname: Kroft
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.|The Interuniversity Cardiology Institute of the Netherlands, Utrecht, The Netherlands.
authors.forename: J
authors.initials: J
authors.lastname: Wouter Jukema
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands.
authors.forename: Jeroen J
authors.initials: JJ
authors.lastname: Bax
authors.affiliation: Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, Postal zone 2300 RC, 2333 ZA, Leiden, The Netherlands. a.j.h.a.scholte@lumc.nl.
authors.forename: Arthur J
authors.initials: AJ
authors.lastname: Scholte
mesh_terms: D054058:Acute Coronary Syndrome / Q000000981:diagnostic imaging* / Q000401:mortality; D015897:Comorbidity; D017023:Coronary Angiography / Q000706:statistics & numerical data*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000401:mortality; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D049690:History, Ancient; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D015995:Prevalence; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000706:statistics & numerical data*; D061205:Vascular Calcification / Q000000981:diagnostic imaging* / Q000401:mortality*
keywords: Computed tomography (CT); atherosclerosis; diabetes; diagnostic and prognostic application