Abstract
Background: Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD). In the present study, we investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. A total of 161 consecutive asymptomatic patients (male/female: 111/50, age: 57.3 ± 9.3 years) with type 2 DM without any known CAD underwent CCTA. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated. Results: Current smoking (OR, 4.069; 95% C.I., 1.578–10.493, p = 0.0037) and the Agatston score ≥100 (OR, 18.034; 95% C.I., 6.337–51.324, p = 0.0001) were independent predictive factors for obstructive CAD, while current smoking (OR, 5.013; 95% C.I., 1.683–14.931, p = 0.0038) was an independent predictive factor for CT-HRP. Furthermore, insulin treatment (OR, 5.677; 95% C.I., 1.223–26.349, p = 0.0266) was the only predictive factor that correlated with optimal revascularization within 90 days. Conclusions: In asymptomatic patients with type 2 DM, current smoking, an Agatston score ≥100, and insulin treatment were independent predictive factors of patients being at high-risk for CAD. However, non-invasive examinations except for Agatston score were not independent predictors of patients being at high risk of CAD.
Highlights
Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD) because they more frequently develop CAD than non-DM patients, and CAD progresses without symptoms and occasionally follows a serious clinical course [1–5]
Patients with DM are widely recognized as a high-risk group for CAD [1–5], screening using non-invasive examinations did not contribute to improvements in patient outcomes in any large-scale clinical studies, including the DIAD study [6], which used myocardial perfusion imaging on asymptomatic patients with DM, and the FACTOR-64 study [27], which used coronary computed tomographic angiography (CCTA)
Since none of the non-invasive screening examinations were independent predictors of patients being at high risk of CAD in the present study, it may be possible to efficiently select high-risk groups for CAD among asymptomatic patients with type 2 DM by selectively performing CCTA on smokers and insulin users, who are at a high risk of developing CAD, and this will contribute to risk stratification and improvements in patient outcomes through early multifactorial therapeutic interventions, as previous reported [50], as well as the prevention of cardiovascular events
Summary
Patients with diabetes mellitus (DM) are a high-risk group for coronary artery disease (CAD) because they more frequently develop CAD than non-DM patients, and CAD progresses without symptoms and occasionally follows a serious clinical course [1–5]. Between October 3, 2015 to March 31, 2020, 452 consecutive asymptomatic patients (35-70 years) with type 2 DM who were provided with a-week hospitalization diabetes education program. We investigated predictive factors to identify patients at high risk of CAD among asymptomatic patients with type 2 DM based on coronary computed tomographic angiography (CCTA) findings. Methods: A single-center prospective study was performed on 452 consecutive patients with type 2 DM who were provided with a weekly hospital-based diabetes education program between 3 October 2015, and 31 March 2020. Based on conventional coronary risk factors and non-invasive examination, i.e., measurement of intima-media thickness, subcutaneous and visceral fat area, a stress electrocardiogram test, and the Agatston score, patients with obstructive CAD, CT-verified high-risk plaques (CT-HRP), and optimal revascularization within 90 days were evaluated.
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