title: Coronary Computed Tomography (CT) Angiography as a Predictor of Cardiac and Noncardiac Vascular Events in Asymptomatic Type 2 Diabetics: A 7-Year Population-Based Cohort Study.
abstract: Type 2 diabetics are at increased risk for vascular events, but the value of further risk stratification for coronary heart disease (CHD) in asymptomatic subjects is unclear. We examined the added value of coronary computed tomography angiography over clinical risk scores (United Kingdom Prospective Diabetes Study), and coronary artery calcium in a population-based cohort of asymptomatic type 2 diabetics.
  
  
  
  Subjects (n=630) underwent baseline clinical assessment and computed tomography angiography (64-slice scanner). Plaque site, volume, calcific content, and arterial remodeling were recorded using dedicated software. Coronary, macrovascular, and microvascular-related events were assessed over 6.6±0.6 (mean±SD) (range 5.4-7.5) years and all CHD events were adjudicated. Discrimination of CHD events (cardiovascular death, myocardial infarction, unstable angina, or new-onset angina requiring intervention) (n=41) was improved by addition of total plaque burden to the clinical risk and coronary artery calcium scores combined (C=0.789 versus 0.763, P=0.034) and further improved by addition of an angiographic score (C=0.824, P=0.021). Independent predictors of a CHD event were United Kingdom Prospective Diabetes Study risk score (hazard ratio 1.3 per 10% 10-year risk, P=0.003) and the angiographic score (hazard ratio 3.2 per quartile, P<0.0001). Classification was improved over that by United Kingdom Prospective Diabetes Study and coronary artery calcium scores alone (overall net reclassification improvement 0.24). In subjects with coronary plaque (N=500), mild plaque calcification independently predicted a CHD event (hazard ratio 3.0, P=0.02). Computed tomography angiography predicted combined macrovascular but not microvascular-related events.
  
  
  
  Computed tomography angiography provides additional prognostic information in asymptomatic type 2 diabetics not obtainable from clinical risk assessment and coronary artery calcium alone.
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel Technion, Israel Institute of Technology, Haifa, Israel halondav@technion.ac.il.
authors.forename: David A
authors.initials: DA
authors.lastname: Halon
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
authors.forename: Mali
authors.initials: M
authors.lastname: Azencot
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Ronen
authors.initials: R
authors.lastname: Rubinshtein
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel.
authors.forename: Barak
authors.initials: B
authors.lastname: Zafrir
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Moshe Y
authors.initials: MY
authors.lastname: Flugelman
authors.affiliation: Department of Cardiovascular Medicine, Lady Davis Carmel Medical Center, Haifa, Israel Technion, Israel Institute of Technology, Haifa, Israel.
authors.forename: Basil S
authors.initials: BS
authors.lastname: Lewis
mesh_terms: D015331:Cohort Studies; D000072226:Computed Tomography Angiography / Q000379:methods; D017023:Coronary Angiography / Q000379:methods; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000517:prevention & control; D023921:Coronary Stenosis / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000000981:diagnostic imaging* / Q000517:prevention & control; D003925:Diabetic Angiopathies / Q000000981:diagnostic imaging* / Q000517:prevention & control; D042241:Early Diagnosis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000517:prevention & control; D011446:Prospective Studies; D018570:Risk Assessment / Q000379:methods; D061205:Vascular Calcification / Q000000981:diagnostic imaging
keywords: computed tomography angiography; coronary disease; diabetes mellitus; plaque; risk stratification