title: Prognostic value of coronary CT angiography in diabetic patients: a 5-year follow up study.
abstract: Prevalence of coronary artery disease (CAD) is high in diabetic patients while diagnosis of early stage of CAD remains demanding. This study evaluates prognostic value of coronary computed tomography angiography (CCTA) for long-term outcome to predict cardiac events in oligosymptomatic diabetic patients. A cohort of 108 consecutive diabetic patients without angina pectoris or known CAD, undergoing CCTA was included. 1379 consecutive patients without diabetes were defined as a control group. Coronary artery calcium score (CACS), segment involvement score (SIS) and the segment stenosis score (SSS) were documented. The end point was a composite of cardiac events defined as all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization. Follow up period was 66.0 ± 14.2 month. 98% of initially enrolled patient were followed. During follow-up period 10 cardiac events within the diabetic cohort and 48 within the non-diabetic cohort were observed. Annual event rate in diabetic and non-diabetic patients was 1.74 and 0.64% respectively. In diabetic patients a multivariate analysis showed significant prognostic value over Framingham Score for SIS with a hazard ratio (HR) of 2.98 (95% CI 1.02, 8.72; p = 0.047) and SSS (HR 4.47, 95% CI 1.21, 16.49; p = 0.025), while CACS did not add prognostic value in this cohort. Annual event rate was 0% in diabetic patients with SIS = 0 and 3.9% in diabetic patients with SIS ≥ 8. CCTA allows for improved risk prediction for subsequent cardiac events in oligosymptomatic diabetic patients.
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany. j.nadjiri@gmx.net.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Nadjiri
authors.affiliation: Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Hausleiter
authors.affiliation: Medizinische Klinik und Poliklinik I, Klinikum der Ludwig-Maximilians-Universität München, Munich, Germany.
authors.forename: Simon
authors.initials: S
authors.lastname: Deseive
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Albrecht
authors.initials: A
authors.lastname: Will
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Eva
authors.initials: E
authors.lastname: Hendrich
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany.
authors.forename: Stefan
authors.initials: S
authors.lastname: Martinoff
authors.affiliation: Institut für Radiologie und Nuklearmedizin, Deutsches Herzzentrum München, Technische Universität München, Lazarettstrasse 36, 80636, Munich, Germany. mhy@dhm.mhn.de.
authors.forename: Martin
authors.initials: M
authors.lastname: Hadamitzky
mesh_terms: D000368:Aged; D000789:Angina, Unstable / Q000209:etiology; D016022:Case-Control Studies; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003925:Diabetic Angiopathies / Q000150:complications / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D009203:Myocardial Infarction / Q000209:etiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: Coronary artery disease; Coronary computed tomographic angiography; Diabetic patients; Plaque load; Prognostic value