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Original Research

Prognostic Value of Coronary Computed Tomographic Angiography in Diabetic Patients Without Known Coronary Artery Disease

  1. Martin Hadamitzky, MD1⇓,
  2. Franziska Hein, MD1,
  3. Tanja Meyer, MD1,
  4. Bernhard Bischoff, MD1,
  5. Stefan Martinoff, MD2,
  6. Albert Schömig, MD1 and
  7. Jörg Hausleiter, MD1
  1. 1Klinik für Herz- und Kreislauferkrankungen, Deutsches Herzzentrum München, Hospital at the Technische Universität München, Munich, Germany;
  2. 2Institut für Radiologie und Nuklearmedizin; Deutsches Herzzentrum München, Hospital at the Technische Universität München, Munich, Germany.
  1. Corresponding author: Martin Hadamitzky, mhy{at}dhm.mhn.de.
Diabetes Care 2010 Jun; 33(6): 1358-1363. https://doi.org/10.2337/dc09-2104
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Abstract

OBJECTIVE Diabetic patients have a high prevalence of coronary artery disease (CAD), but timely diagnosis of CAD remains challenging. We assessed the ability of coronary computed tomography angiography (CCTA) to detect CAD in diabetic patients and to predict subsequent cardiac events.

RESEARCH DESIGN AND METHODS We analyzed 140 diabetic patients without known CAD undergoing CCTA; 1,782 patients without diabetes were used as a control group. Besides calcium scoring and the degree of the most severe stenosis, the atherosclerotic burden score counting the number of segments having either a nonstenotic plaque or a stenosis was recorded. The primary end point was a composite of hard cardiac events defined as all-cause death, nonfatal myocardial infarction, or unstable angina requiring hospitalization.

RESULTS During a mean follow-up of 33 months, there were seven events in the diabetic group and 24 events in the control group. The best predictor in diabetic patients was the atherosclerotic burden score: the annual event rate ranged from 0.5% for patients with <5 lesions to 9.6% for patients with >9 lesions, resulting in a hazard ratio (HR) of 1.3 (95% CI 1.1–1.7) for each additional lesion (P = 0.005). For comparison, in nondiabetic patients the annual event rate ranged from 0.3 to 2.2%, respectively, resulting in an HR of 1.2 (95% CI 1.1–1.3, P < 0.001). The atherosclerotic burden score improved the prognostic value of conventional risk factors significantly (P < 0.001).

CONCLUSIONS In diabetic patients without known CAD, CCTA can identify a patient group at particularly high risk for subsequent hard cardiac events.

Footnotes

  • The costs of publication of this article were defrayed in part by the payment of page charges. This article must therefore be hereby marked “advertisement” in accordance with 18 U.S.C. Section 1734 solely to indicate this fact.

  • Received November 16, 2009.
  • Accepted February 22, 2010.
  • © 2010 by the American Diabetes Association.

Readers may use this article as long as the work is properly cited, the use is educational and not for profit, and the work is not altered. See http://creativecommons.org/licenses/by-nc-nd/3.0/ for details.

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Diabetes Care: 33 (6)

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June 2010, 33(6)
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Prognostic Value of Coronary Computed Tomographic Angiography in Diabetic Patients Without Known Coronary Artery Disease
Martin Hadamitzky, Franziska Hein, Tanja Meyer, Bernhard Bischoff, Stefan Martinoff, Albert Schömig, Jörg Hausleiter
Diabetes Care Jun 2010, 33 (6) 1358-1363; DOI: 10.2337/dc09-2104

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Prognostic Value of Coronary Computed Tomographic Angiography in Diabetic Patients Without Known Coronary Artery Disease
Martin Hadamitzky, Franziska Hein, Tanja Meyer, Bernhard Bischoff, Stefan Martinoff, Albert Schömig, Jörg Hausleiter
Diabetes Care Jun 2010, 33 (6) 1358-1363; DOI: 10.2337/dc09-2104
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