Journal of cardiovascular computed tomography · 2025
Impact of diabetes mellitus on coronary artery plaque characteristics and outcomes in the SCOT-HEART trial.
СтатьяМногоцентровое исследованиеРандомизированное исследованиеНазвание и аннотация: Перевод пока не подготовлен
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Gebert Zuzanna M, Kwiecinski Jacek, Weir-McCall Jonathan R, Adamson Philip D, Mills Nicholas L, Roditi Giles, van Beek Edwin J R, Nicol Edward D, Berman Daniel S, Slomka Piotr J, Dweck Marc R, Dey Damini, Newby David E, Williams Michelle C
Аннотация
BACKGROUND: Diabetes mellitus is an established cardiovascular risk factor. We assessed the impact of diabetes mellitus on quantitative plaque and long-term outcomes in patients with and without diabetes mellitus in the Scottish COmputed Tomography of the HEART (SCOT-HEART) trial.
METHODS: Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed.
RESULTS: Images of 1769 patients were assessed (56 % male, 58 ± 9 years). Diabetes mellitus was present in 196 (11 %) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p < 0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p < 0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p = 0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95 % confidence interval 1.09 to 3.17, p = 0.024).
CONCLUSION: Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.
METHODS: Coronary artery calcium (CAC) was assessed on non-contrast computed tomography (CT). Coronary stenoses, visually assessed adverse plaque characteristics and quantitative plaque burdens (calcified, non-calcified, low attenuation and total, Autoplaque 2.5) were assessed on coronary CT angiography. Multivariable and survival analyses were performed.
RESULTS: Images of 1769 patients were assessed (56 % male, 58 ± 9 years). Diabetes mellitus was present in 196 (11 %) patients. Patients with diabetes mellitus had higher 10-year cardiovascular risk score (29 [interquartile range 21, 40] versus 15 [9, 21] %, p < 0.001) and CAC score (71 [1, 447] versus 17 [0, 209] Agatston units, p < 0.001), but were not more likely to have obstructive disease or visually assessed adverse plaque characteristics. Patients with diabetes mellitus had higher quantitatively assessed calcified, non-calcified, low attenuation and total plaque burdens. After adjustment for age and sex, diabetes mellitus was an independent predictor of calcified plaque burden (p = 0.009), but not the other plaque types. During 8.7 [IQR 8, 9.6] years follow-up, diabetes mellitus was associated with an increased risk of fatal or non-fatal myocardial infarction, adjusted for age and sex (hazard ratio 1.85, 95 % confidence interval 1.09 to 3.17, p = 0.024).
CONCLUSION: Diabetes mellitus was an independent predictor of quantitatively assessed plaque burden, particularly calcified plaque, and was associated with an increased risk of myocardial infarction.
Предметные рубрики MeSH
HumansMaleFemaleMiddle AgedPlaque, AtheroscleroticCoronary Artery DiseaseCoronary AngiographyVascular CalcificationComputed Tomography AngiographyAgedRisk FactorsCoronary VesselsDiabetes MellitusPredictive Value of TestsTime FactorsScotlandPrognosisProportional Hazards ModelsMultivariate AnalysisCoronary StenosisKaplan-Meier EstimateMultidetector Computed TomographySeverity of Illness IndexRisk AssessmentMyocardial InfarctionHeart Disease Risk Factors