Coronary Computed Tomographic Angiographic Findings in Asymptomatic Patients With Type 2 Diabetes Mellitus - 12/02/14
, Young-Rak Cho, MD c, Chan Joon Kim, MD a, Jung Sun Cho, MD a, Mahn-Won Park, MD a, Sung Ho Her, MD a, Jung-Min Ahn, MD b, Jong-Young Lee, MD b, Duk-Woo Park, MD b, Soo-Jin Kang, MD b, Young-Hak Kim, MD b, Cheol Whan Lee, MD b, Eun Hee Koh, MD d, Woo Je Lee, MD d, Min-Seon Kim, MD d, Ki-Up Lee, MD d, Joon-Won Kang, MD e, Tae-Hwan Lim, MD e, Seong-Wook Park, MD b, Seung-Jung Park, MD b, Joong-Yeol Park, MD dAbstract |
There are limited data regarding the role of coronary computed tomographic angiography (CCTA) in asymptomatic patients with type 2 diabetes mellitus. We analyzed 557 asymptomatic type 2 diabetic patients who underwent CCTA. Cardiac event was defined as a composite of cardiac death, nonfatal myocardial infarction, acute coronary syndrome requiring hospitalization, or late revascularization. Atherosclerotic plaques were observed in 395 patients (70.9%), and 170 patients (30.5%) showed significant coronary artery disease (CAD) on CCTA. Ninety-two patients (16.5%) were associated with a significant stenosis in the left main or proximal left anterior descending artery. During the follow-up period (33.7 ± 7.8 months), although an excellent prognosis was observed in patients without significant CAD on CCTA, those with significant CAD showed more cardiac events (7.1% vs 0.5%) and lower 3-year event-free survival rates (99.2 ± 0.6% vs 90.9 ± 2.6%, p <0.001). Furthermore, in group with significant CAD, patients with significant CAD in the left main or proximal left anterior descending artery had more cardiac events (10.9% vs 2.6%) and lower 3-year event-free survival rates (97.4 ± 1.8% vs 86.1 ± 4.2%, p = 0.049). On multivariate analysis, family history of premature CAD, previous history of stroke, higher UK Prospective Diabetes Study 10-year risk scores, neuropathy, and retinopathy were independent clinical predictors of having significant CAD and left main or proximal left anterior descending artery significant CAD on CCTA. In conclusion, about 1/3 of asymptomatic type 2 diabetic patients had significant CAD on CCTA with a subsequent high risk for cardiac events. These findings suggest that CCTA may have a potential role in identifying patients with high cardiovascular risks in asymptomatic type 2 diabetes.
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Vol 113 - N° 5
P. 765-771 - mars 2014 Retour au numéro
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