Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study |
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| Affiliation: | 1. Centro Cardiologico Monzino, IRCCS, Milan, Italy;2. Department of Biomedical and Clinical Sciences “Luigi Sacco”, University of Milan, Milan, Italy;3. Cardiology Division, Castiglione delle Siviere Hospital, Mantova, Italy;1. Department of Epidemiology, School of Public Health and Jiangsu Key Laboratory of Preventive and Translational Medicine for Geriatric Diseases, Medical College of Soochow University, Suzhou, China;2. Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA;3. Department of Neurology, Affiliated Hospital of Nantong University, Nantong, China;4. Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA;1. Diabetology, Careggi Hospital and University of Florence, Italy;2. Centro per le Malattie Endocrine e Metaboliche, Fondazione Policlinico Universitario A. Gemelli IRCCS and Università Cattolica Del Sacro Cuore, Rome, Italy;3. Endocrinology and Metabolic Diseases Unit, Azienda Ospedaliera SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy;4. Endocrinology, Diabetes and Metabolism, University of Verona, Italy;5. SSD Diabetes Unit, Niguarda Ca’ Granda Hospital, Milan, Italy;6. Diabetes Centre District 3, Azienda Sanitaria Universitaria Integrata di Trieste, Via Puccini 48/50, 34100, Trieste, Italy |
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| Abstract: | Background and aimsThe aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk).Methods and resultsThe study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up.Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65–21.87), p = 0.006 and 3.46 (2.00–5.97); p < 0.001].ConclusionThe present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries. |
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| Keywords: | Coronary artery disease Vulnerable coronary plaque Prognosis Cardiac CT Diabetes |
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