title: Combined arteriosclerotic assessment of ankle-brachial index and maximum intima-media thickness via CCTA is useful for predicting coronary artery stenosis in patients with type 2 diabetes.
abstract: OBJECTIVE
  Patients with diabetes mellitus (DM) are likely to develop asymptomatic myocardial infarction as a complication. However, coronary artery lesions are difficult to assess in internal medicine. This study aimed to develop a prediction formula for coronary artery stenosis, as determined by coronary computed tomographic angiography (CCTA), by analyzing risk factors in patients with type 2 DM.
  
  
  METHODS
  A prediction formula was developed based on a multivariate analysis of common factors in patients with ⩾50% coronary artery stenosis in a cohort of 327 patients with type 2 DM who underwent CCTA between 2007 and 2009, and cutoff values were calculated (derivation study). The validity of the optimal cutoff value was confirmed in a separate cohort of 317 patients with type 2 DM who underwent CCTA between 2010 and 2011 (validation study).
  
  
  RESULTS
  In the derivation study, five predictive factors (presence/absence of hypertension, estimated glomerular filtration rate, maximum intima-media thickness [max-IMT], ankle-brachial index [ABI], and use/nonuse of diabetic medication) were used to develop a prediction formula. In the validation study, positive predictive value (PPV) and negative predictive value (NPV) of the cutoff value derived from the prediction formula were 53% and 73%, respectively.
  
  
  CONCLUSIONS
  We developed a novel formula to predict coronary artery stenosis using five predictive factors. This formula is useful for determining whether computed tomography (CT) examination is necessary, even in clinical settings without CCTA equipment. Early detection of coronary artery stenosis in patients with DM may also lead to better health outcomes.
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan; Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan. Electronic address: akira.y@jinnouchi.or.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Yoshida
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Hideaki
authors.initials: H
authors.lastname: Jinnouchi
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Seigo
authors.initials: S
authors.lastname: Sugiyama
authors.affiliation: Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan.
authors.forename: Jun
authors.initials: J
authors.lastname: Hirose
authors.affiliation: Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan.
authors.forename: Tateki
authors.initials: T
authors.lastname: Segata
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Kazue
authors.initials: K
authors.lastname: Furuta
authors.affiliation: Department of Diagnostic Radiology, Kumamoto Chuo Hospital, 1-5-1 Tainoshima, Minami-ku, Kumamoto 862-0965, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Katahira
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Keizo
authors.initials: K
authors.lastname: Kajiwara
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Kunio
authors.initials: K
authors.lastname: Hieshima
authors.affiliation: Jinnouchi Clinic, 6-2-3 Kuhonji, Chuo-ku, Kumamoto 862-0976, Japan.
authors.forename: Tomio
authors.initials: T
authors.lastname: Jinnouchi
authors.affiliation: Department of Medical Information Sciences and Administration Planning, Kumamoto University Hospital, 1-1-1 honjo, Chuo-ku, 860-8556 Kumamoto, Japan.
authors.forename: Koichiro
authors.initials: K
authors.lastname: Usuku
mesh_terms: D000328:Adult; D000368:Aged; D055109:Ankle Brachial Index; D059168:Carotid Intima-Media Thickness; D017023:Coronary Angiography / Q000379:methods*; D023921:Coronary Stenosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000209:etiology; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000000981:diagnostic imaging; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D014057:Tomography, X-Ray Computed / Q000379:methods*
keywords: Ankle-brachial index; Coronary artery stenosis; Risk factors; Type 2 diabetes mellitus