Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry - 28/02/23

Doi : 10.1016/j.hlc.2022.09.014

Juhwan Lee, MD ^a,^b, Kashif Shaikh, MD ^a,^c, Rine Nakanishi, MD ^a,^d, Heidi Gransar, MSc ^e, Stephan Achenbach, MD ^f, Mouaz H. Al-Mallah, MD ^g, Daniele Andreini, MD, PhD ^h, Jeroen J. Bax, MD, PhD ⁱ, Daniel S. Berman, MD ^e, Filippo Cademartiri, MD, PhD ^j, Tracy Q. Callister, MD ^k, Hyuk-Jae Chang, MD, PhD ^l, Kavitha Chinnaiyan, MD ^m, Benjamin J.W. Chow, MD ⁿ, Ricardo C. Cury, MD ^o, Augustin DeLago, MD ^p, Gudrun Feuchtner, MD ^q, Martin Hadamitzky, MD ^r, Joerg Hausleiter, MD ^s, Philipp A. Kaufmann, MD ^t, Yong-Jin Kim, MD, PhD ^u, Jonathon A. Leipsic, MD ^v, Erica Maffei, MD ^j, Hugo Marques, MD, PhD ^w, Pedro de Araújo Gonçalves, MD, PhD ^w, Gianluca Pontone, MD, PhD ^x, Ronen Rubinshtein, MD ^y, Todd C. Villines, MD ^z, Yao Lu, MSc ^A, Jessica M. Peña, MD ^B, Fay Y. Lin, MD ^B, James K. Min, MD ^C, Leslee J. Shaw, PhD ^B, Matthew J. Budoff, MD ^a,^⁎
^a Department of Medicine, Lundquist Institute at Harbor-UCLA Medical Center, Torrance, CA, USA
^b Department of Medicine, CHA University GUMI CHA Hospital, Gyeongsangbuk-do, South Korea
^c Department of Medicine, University of Tennessee, Knoxville, Tennessee, USA
^d Department of Cardiovascular Medicine, Toho University Graduate School of Medicine, Tokyo, Japan
^e Department of Imaging and Medicine, Cedars Sinai Medical Center, Los Angeles, CA, USA
^f Department of Cardiology, Friedrich-Alexander-University Erlangen-Nuremburg, Erlangen, Germany
^g Houston Methodist DeBakey Heart & Vascular Center, Houston Methodist Hospital, Houston, TX, USA
^h Centro Cardiologico Monzino, IRCCS Milan, Milan, Italy
ⁱ Department of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
^j Department of Radiology, Fondazione Monasterio/CNR, Pisa/Massa, Italy
^k Tennessee Heart and Vascular Institute, Hendersonville, TN, USA
^l Division of Cardiology, Severance Cardiovascular Hospital and Severance Biomedical Science Institute, Yonsei University College of Medicine, Yonsei University Health System, Seoul, South Korea
^m Department of Cardiology, William Beaumont Hospital, Royal Oak, MI, USA
ⁿ Department of Medicine and Radiology, University of Ottawa, Ottawa, ON, Canada
^o Department of Radiology, Miami Cardiac and Vascular Institute, Miami, FL, USA
^p Capitol Cardiology Associates, Albany, NY, USA
^q Department of Radiology, Medical University of Innsbruck, Innsbruck, Austria
^r Department of Radiology and Nuclear Medicine, German Heart Center Munich, Munich, Germany
^s Medizinische Klinik I der Ludwig-Maximilians-Universität München, Munich, Germany
^t Department of Nuclear Medicine, University Hospital, Zurich, Zurich, Switzerland
^u Seoul National University Hospital, Seoul, South Korea
^v Department of Medicine and Radiology, University of British Columbia, Vancouver, BC, Canada
^w UNICA, Unit of Cardiovascular Imaging, Hospital da Luz, Lisboa, Portugal
^x Centro Cardiologico Monzino, IRCCS Milan, Italy
^y 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
^z Division of Cardiovascular Medicine, Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA
^A Department of Healthcare Policy and Research, New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, NY, USA
^B Dalio Institute of Cardiovascular Imaging, Weill Cornell Medicine and NewYork-Presbyterian, New York, NY, USA
^C Cleerly Inc, New York, NY, USA

^∗Corresponding author at: 1124 West Carson Street Torrance, CA 90502, USA1124 West Carson Street TorranceCA90502USA

Abstract

Background

Prognostic significance of non-obstructive left main (LM) disease was recently reported. However, the influence of diabetes mellitus (DM) on event rates in patients with and without non-obstructive LM disease is not well-known.

Methods

We evaluated 27,252 patients undergoing coronary computed tomographic angiography from the COroNary CT Angiography Evaluation For Clinical Outcomes: An InteRnational Multicenter (CONFIRM) Registry. Cumulative long-term incidence of all-cause mortality (ACM) was assessed between DM and non-DM patients by normal or non-obstructive LM disease (1–49% stenosis).

Results

The mean age of the study population was 57.6 12.6 years. Of the 27,252 patients, 4,434 (16%) patients had DM. A total of 899 (3%) deaths occurred during the follow-up of 3.6±1.9. years. Compared to patients with normal LM, those with non-obstructive LM had more pronounced overall coronary atherosclerosis and more cardiovascular risk factors. After clinical risk factors, segment involvement score, and stenosis severity adjustment, compared to patients without DM and normal LM, patients with DM were associated with increased ACM regardless of normal (HR 1.48, 95% CI 1.22–1.78, p<0.001) or non-obstructive LM (HR 1.46, 95% CI 1.04–2.04, p=0.029), while nonobstructive LM disease was not associated with increased ACM in patients without DM (HR 0.85, 95% CI 0.67–1.07, p=0.165) and there was no significant interaction between DM and LM status (HR 1.03, 95% CI 0.69–1.54, p=0.879).

Conclusion

From the CONFIRM registry, we demonstrated that DM was associated with increased ACM. However, the presence of non-obstructive LM was not an independent risk marker of ACM, and there was no significant interaction between DM and non-obstructive LM disease for ACM.

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Keywords : Coronary computed tomographic angiography, Diabetes mellitus, Nonobstructive coronary artery disease, Left main, All-cause mortality

Plan

Introduction

Methods

Study Population

Image Acquisition and Analysis

Patient Follow-Up

Statistical Analysis

Results

Clinical and CCTA Characteristics of the Study Population

Outcomes According to Diabetes and Left Main Disease

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Vol 32 - N° 2

P. 175-183 - février 2023 Retour au numéro

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Prognostic Significance of Nonobstructive Left Main Coronary Artery Disease in Patients With and Without Diabetes: Long-Term Outcomes From the CONFIRM Registry - 28/02/23

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