Germany: Coronary CT angiography (CCTA) derived plaque information may improve heart disease risk assessment in diabetes patients compared with assessment of obstructive stenosis on CCTA alone, a recent study has found. The results, published in the Journal of Thoracic Imaging, portend improved risk stratification in both patients with and without diabetes.
Diabetes is associated with a significantly higher extent of coronary artery disease and plaque features, which have independent predictive values for MACE. Christian Tesche, Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, and colleagues aimed to investigate the long-term prognostic value of coronary computed tomography angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus.
The study included 64 patients with diabetes (63.3±10.1 y, 66% male) and suspected coronary artery disease who underwent cCTA matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, and statin and antithrombotic therapy.
MACE was recorded. CCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated.
The study yielded the following findings:
After a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%).
In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared with nondiabetic patients.
The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR=1.20), low-attenuation plaque (HR=3.47), and in nondiabetic patients: segment stenosis score (HR=1.92), Agatston score (HR=1.0009), and low-attenuation plaque (HR=4.15).
A multivariable model showed a significantly improved C-index of 0.96 for MACE prediction, when compared with single measures alone.
"cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond the assessment of obstructive stenosis on cCTA alone with subsequent impact on individualized treatment decision-making, the author summed up.
Reference:
Tesche, Christian MD*,†,‡,§; Baquet, Moritz MD*; Bauer, Maximilian J. MD†,§; Straube, Florian MD†; Hartl, Stefan MD∥; Leonard, Tyler BSc§; Jochheim, David MD*; Fink, David Med†; Brandt, Verena MD§,¶; Baumann, Stefan MD§,#; Schoepf, U. Joseph MD§,**; Massberg, Steffen MD*; Hoffmann, Ellen MD†; Ebersberger, Ullrich MD*,†,§,†† Prognostic Utility of Coronary Computed Tomography Angiography-derived Plaque Information on Long-term Outcome in Patients With and Without Diabetes Mellitus, Journal of Thoracic Imaging: October 28, 2021 - Volume - Issue - doi: 10.1097/RTI.0000000000000626