Predictive value of coronary computed tomography angiography in asymptomatic individuals with diabetes mellitus: Systematic review and meta-analysis |
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| Institution: | 1. Department of Radiology, University Hospital, LMU Munich, Germany;2. Department of Diagnostic and Interventional Radiology, University Hospital, Rostock, Germany;3. Medizinische Klinik und Poliklinik I, Ludwig Maximilians University, Munich, Germany;4. Department of Radiology, University of Tübingen, Germany;5. Department of Radiology and Radiological Science, Medical University of South Carolina, Charleston, SC, USA;6. Division of Cardiology, Department of Medicine, Medical University of South Carolina, Charleston, SC, USA;7. Institute of Biomedical Informatics, Biometry and Epidemiology, Ludwig Maximilians University, Munich, Germany;8. Department of Infectious Diseases & Tropical Medicine, Ludwig-Maximilians University, Germany;1. Department of Medicine, Brigham and Women''s Hospital, Boston, MA, USA;2. Department of Radiology, Brigham and Women''s Hospital, Boston, MA, USA;1. Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA;2. Mark S. Taper Imaging Center, Cedars-Sinai Medical Center, Los Angeles, CA, USA;3. Holy Cross Hospital, Los Angeles, CA, USA;1. Department of Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China;2. Department of Interventional Radiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China;3. Department of Cardiology, BenQ Medical Center, Nanjing Medical University, 71 Hexi Street, Jianye District, Nanjing 210019, China;1. Department of Vascular Surgery, Aalborg University Hospital, Aalborg, Denmark;2. Department of Cardiology, Aalborg University Hospital, Aalborg, Denmark;3. Department of Public Health, Section for Epidemiology, Aarhus University, Aarhus, Denmark;4. Unit of Clinical Biostatistics and Bioinformatics, Aalborg University Hospital, Aalborg, Denmark;5. UNIT of Diet, Genes and Environment, Danish Cancer Society Research Centre, Copenhagen, Denmark;6. Faculty of Medicine, Aalborg University, Aalborg, Denmark;1. Mazankowski Alberta Heart Institute, University of Alberta, Edmonton, Alberta, Canada;2. Department of Medicine, University of Alberta, Edmonton, Alberta, Canada |
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| Abstract: | BackgroundCoronary CT angiography (CTA) is generally not established as a screening tool for asymptomatic individuals. However, it is controversial whether this test may have a role for screening asymptomatic individuals with diabetes mellitus (DM) due to the high prevalence of asymptomatic coronary artery disease (CAD) in this subgroup.MethodsWe searched PubMed and EMBASE through May 2017 for studies that reported on the association between findings at coronary CTA and future cardiac events in asymptomatic individuals with DM. Summary hazard ratios for the presence of obstructive CAD (≥50% stenosis), presence of non-obstructive plaque (<50% stenosis), segment involvement score, and segment stenosis score were derived using a random effects regression model. I2 was calculated to quantify between-study heterogeneity and causing factors were identified using meta-regression.ResultsA total of 10 studies reporting on 5012 individuals with DM (median age: 62.3 years, median proportion of women: 40.5%) were included in the analysis. The presence of obstructive CAD on coronary CTA (vs. non-obstructive or no CAD) was associated with a significantly elevated risk for adverse events (summary HR: 4.07, 95% CI: 2.30 to 7.21). The estimated summary HR for non-obstructive plaque (vs. no CAD) was 2.17 (95% CI: 1.11 to 4.25). The pooled HRs per unit for segment stenosis score and segment involvement score were 1.44 (95% CI: 0.98 to 2.12), and 1.73 (95% CI: 1.07 to 2.80) respectively. On meta-regression analysis, we observed a trend towards a higher risk estimate in studies with a higher proportion of females (p = 0.1063).ConclusionThe presence and extent of CAD on coronary CTA are strong, independent predictors of cardiovascular events in asymptomatic individuals with DM despite heterogeneity between studies in endpoints, study population and length of follow-up. |
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| Keywords: | Coronary artery disease Diabetes mellitus Asymptomatic Screening Computed tomography |
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