title: Long-Term Prognostic Utility of Coronary CT Angiography in Stable Patients With Diabetes Mellitus.
abstract: The goal of this study was to determine the long-term prognostic value of coronary computed tomography angiography (CTA) among patients with diabetes mellitus (DM) compared with nondiabetic subjects.
  
  
  
  The long-term prognostic value of coronary CTA in patients with DM is not well established.
  
  
  
  Patients enrolled in the CONFIRM (Coronary CT Angiography Evaluation for Clinical Outcomes: An International Multicenter) registry with 5-year follow-up data were identified. The extent and severity of coronary artery disease (CAD) were analyzed at baseline coronary CTA and in relation to outcomes between diabetic and nondiabetic patients. CAD according to coronary CTA was defined as none (0% stenosis), nonobstructive (1% to 49% stenosis), or obstructive (≥50% stenosis). Time to death (and in a subgroup, time to major adverse cardiovascular event) was estimated by using multivariable Cox proportional hazards models.
  
  
  
  A total of 1,823 patients were identified as having DM with 5-year clinical follow-up and were propensity-matched to 1,823 patients without DM (mean age 61.8 ± 10.9 years; 54.4% male). Patients with DM did not exhibit a heightened risk of death compared with the propensity-matched nondiabetic subjects in the absence of CAD on coronary CTA (risk-adjusted hazard ratio [HR] of DM: 1.32; 95% confidence interval [CI]: 0.78 to 2.24; p = 0.296). Patients with DM were at increased risk of dying compared with nondiabetic subjects in the setting of nonobstructive CAD (in the propensity-matched cohort: HR, 2.10; 95% CI: 1.43 to 3.09; p < 0.001) with a mortality risk greater than nondiabetic subjects with obstructive disease (p < 0.001). In a risk-adjusted hazard analysis among patients with DM, both per-patient obstructive CAD and nonobstructive CAD conferred an increase in all-cause mortality risk compared with patients without atherosclerosis on coronary CTA (nonobstructive disease-HR: 2.07; 95% CI: 1.33 to 3.24; p = 0.001; obstructive disease-HR: 2.22; 95% CI: 1.47 to 3.36; p < 0.001).
  
  
  
  Among patients with DM, nonobstructive and obstructive CAD according to coronary CTA were associated with higher rates of all-cause mortality and major adverse cardiovascular events at 5 years, and this risk was significantly higher than in nondiabetic subjects. Importantly, patients with DM without CAD according to coronary CTA were at a risk comparable to that of nondiabetic subjects.
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Philipp
authors: P
authors: Blanke
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Christopher
authors: C
authors: Naoum
authors: Department of Cardiology, Icahn School of Medicine at Mount Sinai, New York, New York.
authors: Amir
authors: A
authors: Ahmadi
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Chaitu
authors: C
authors: Cheruvu
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Jeanette
authors: J
authors: Soon
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada.
authors: Chesnal
authors: C
authors: Arepalli
authors: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Heidi
authors: H
authors: Gransar
authors: Department of Medicine, University of Erlangen, Erlangen, Germany.
authors: Stephan
authors: S
authors: Achenbach
authors: Department of Imaging, Cedars-Sinai Medical Center, Los Angeles, California.
authors: Daniel S
authors: DS
authors: Berman
authors: Department of Medicine, Harbor-UCLA Medical Center, Los Angeles, California.
authors: Matthew J
authors: MJ
authors: Budoff
authors: Tennessee Heart and Vascular Institute, Hendersonville, Tennessee.
authors: Tracy Q
authors: TQ
authors: Callister
authors: Department of Medicine, Wayne State University, Henry Ford Hospital, Detroit, Michigan.
authors: Mouaz H
authors: MH
authors: Al-Mallah
authors: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Filippo
authors: F
authors: Cademartiri
authors: William Beaumont Hospital, Royal Oaks, Michigan.
authors: Kavitha
authors: K
authors: Chinnaiyan
authors: Department of Cardiology at the Lady Davis Carmel Medical Center, The Ruth and Bruce Rappaport School of Medicine, Technion-Israel Institute of Technology, Haifa, Israel.
authors: Ronen
authors: R
authors: Rubinshtein
authors: Department of Surgery, Curry Cabral Hospital, Lisbon, Portugal.
authors: Hugo
authors: H
authors: Marquez
authors: Capitol Cardiology Associates, Albany, New York.
authors: Augustin
authors: A
authors: DeLago
authors: Department of Medicine, Walter Reed Medical Center, Washington, D.C.
authors: Todd C
authors: TC
authors: Villines
authors: Division of Cardiology, Deutsches Herzzentrum Munchen, Munich, Germany.
authors: Martin
authors: M
authors: Hadamitzky
authors: Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany.
authors: Joerg
authors: J
authors: Hausleiter
authors: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors: Leslee J
authors: LJ
authors: Shaw
authors: University Hospital, Zurich, Switzerland.
authors: Philipp A
authors: PA
authors: Kaufmann
authors: Baptist Cardiac and Vascular Institute, Miami, Florida.
authors: Ricardo C
authors: RC
authors: Cury
authors: Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria.
authors: Gudrun
authors: G
authors: Feuchtner
authors: Seoul National University Hospital, Seoul, South Korea.
authors: Yong-Jin
authors: YJ
authors: Kim
authors: Cardiovascular Imaging Unit, Giovanni XXIII Hospital, Monastier, Treviso, Italy, and Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands.
authors: Erica
authors: E
authors: Maffei
authors: William Beaumont Hospital, Royal Oaks, Michigan.
authors: Gilbert
authors: G
authors: Raff
authors: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.
authors: Gianluca
authors: G
authors: Pontone
authors: Department of Clinical Sciences and Community Health, University of Milan, Centro Cardiologico Monzino, IRCCS Milan, Italy.
authors: Daniele
authors: D
authors: Andreini
authors: Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea.
authors: Hyuk-Jae
authors: HJ
authors: Chang
authors: Division of Cardiology, University of Ottawa, Ottawa, Ontario, Canada.
authors: Benjamin W
authors: BW
authors: Chow
authors: Department of Radiology, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York.
authors: James
authors: J
authors: Min
authors: Department of Radiology and Division of Cardiology, University of British Columbia, Vancouver, British Columbia, Canada. Electronic address: jleipsic@providencehealth.bc.ca.
authors: Jonathon
authors: J
authors: Leipsic
mesh_terms: D000368:Aged; D000072226:Computed Tomography Angiography; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D023921:Coronary Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy; D003920:Diabetes Mellitus / Q000175:diagnosis / Q000401:mortality / Q000628:therapy; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D015995:Prevalence; D011379:Prognosis; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors
keywords: coronary CT angiography; diabetes mellitus; prognosis