Journal of diabetes and its complications · 2024
Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment.
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Wada Shinichi, Iwanaga Yoshitaka, Nakai Michikazu, Noguchi Teruo, Miyamoto Yoshihiro
Аннотация
BACKGROUND: We aimed to examine the stepwise risk stratification for predicting major adverse cardiovascular events (MACE) in patients with DM and suspected coronary artery disease (CAD).
METHOD: 1187 patients with suspected CAD enrolled in a prospective cohort study were examined. The patients were evaluated step-by-step with coronary artery calcification (CAC), coronary artery stenosis (CAS), and FFRCT analysis. Hazard ratio (HR) and 95 % confidence interval (CI) for incidence MACE were calculated by Cox Proportional Hazards model for adjustment of Framingham risk score.
RESULTS: During a median follow-up of 4.0 years, MACE frequently occurred in DM patients than non-DM (15.9 % vs. 5.7 %). A lower CAC threshold with >0 or > 50 Agatston score was significantly associated with increased MACE in DM (HR [95 % CI], 3.62 [1.12-11.67] or 4.72 [2.11-10.55], respectively), but not in non-DM. DM patients with >50 CAC, CAS, and ≤ 0.71 FFRCT value showed the HR (95 % CI) for MACE was 9.84 (4.26-22.69) as compared with those with ≤50 CAC, whereas non-DM patients showed that it was 2.56 (1.02-6.43).
CONCLUSION: Step-by-step assessment using CAC, CAS, and FFRCT on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.
METHOD: 1187 patients with suspected CAD enrolled in a prospective cohort study were examined. The patients were evaluated step-by-step with coronary artery calcification (CAC), coronary artery stenosis (CAS), and FFRCT analysis. Hazard ratio (HR) and 95 % confidence interval (CI) for incidence MACE were calculated by Cox Proportional Hazards model for adjustment of Framingham risk score.
RESULTS: During a median follow-up of 4.0 years, MACE frequently occurred in DM patients than non-DM (15.9 % vs. 5.7 %). A lower CAC threshold with >0 or > 50 Agatston score was significantly associated with increased MACE in DM (HR [95 % CI], 3.62 [1.12-11.67] or 4.72 [2.11-10.55], respectively), but not in non-DM. DM patients with >50 CAC, CAS, and ≤ 0.71 FFRCT value showed the HR (95 % CI) for MACE was 9.84 (4.26-22.69) as compared with those with ≤50 CAC, whereas non-DM patients showed that it was 2.56 (1.02-6.43).
CONCLUSION: Step-by-step assessment using CAC, CAS, and FFRCT on top of clinical risk factors was useful for more accurate cardiovascular risk stratification in patients with DM.
Предметные рубрики MeSH
HumansFemaleMaleMiddle AgedAgedCoronary Artery DiseaseRisk AssessmentDiabetes Mellitus, Type 2Prospective StudiesVascular CalcificationCohort StudiesCoronary AngiographyCoronary StenosisHeart Disease Risk FactorsFollow-Up StudiesDiabetic AngiopathiesTomography, X-Ray ComputedComputed Tomography AngiographyCoronary VesselsRisk FactorsPrognosis