Stepwise cardiovascular risk stratification in patients with type 2 diabetes based on coronary CT assessment.

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.