Long-Term Prognostic Value of Coronary CT Angiography in Asymptomatic Type 2 Diabetes Mellitus

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• 作者：Se Hun Kang ; MD^a ; Gyung-Min Park ; MD^b ; Seung-Whan Lee ; MD^a ; ^{seungwlee@amc.seoul.kr" class="auth_mail" title="E-mail the corresponding author} ; Sung-Cheol Yun ; PhD^c ; Young-Hak Kim ; MD^a ; Young-Rak Cho ; MD^d ; Hyun Woo Park ; MD^e ; Jon Suh ; MD^e ; Dong Hyun Yang ; MD^f ; Joon-Won Kang ; MD^f ; Tae-Hwan Lim ; MD^f ; Chang Hee Jung ; MD^g ; Eun Hee Koh ; MD^g ; Woo Je Lee ; MD^g ; Min-Seon Kim ; MD^g ; Ki-Up Lee ; MD^g ; Joong-Yeol Park ; MD^g
• 关键词：atherosclerosis ; coronary artery disease ; coronary computed tomography angiography ; diabetes mellitus
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2016
• 出版时间：November 2016
• 年：2016
• 卷：9
• 期：11
• 页码：1292-1300
• 全文大小：358 K

文摘

This study sought to evaluate the long-term prognostic value of coronary computed tomography angiography (CTA) in asymptomatic patients with type 2 diabetes mellitus.

Background

There are limited data on the long-term prognostic impact of coronary CTA in asymptomatic patients with type 2 diabetes mellitus.

Methods

This study analyzed clinical outcomes of 591 consecutive asymptomatic patients with type 2 diabetes mellitus who underwent coronary CTA (mean age 62.2 ± 8.3 years and 352 men [59.6%]). A cardiac event was defined as a composite of cardiac death, nonfatal myocardial infarction, unstable angina requiring hospitalization, or late coronary revascularization. Patients were categorized into 3 groups according to severity of coronary artery disease (CAD) on coronary CTA: normal coronary arteries, nonobstructive CAD (<50%), and obstructive CAD (≥50%).

Results

One hundred sixty-eight patients (28.4%) had normal coronary arteries, whereas 236 (39.9%) patients had nonobstructive CAD and 187 (31.6%) had obstructive CAD. During the follow-up period (median 5.3 years [interquartile range: 4.7 to 5.8 years]), 37 cardiac events occurred in 29 patents: 10 cardiac deaths, 2 nonfatal myocardial infarctions, 8 cases of unstable angina, and 17 late coronary revascularizations. The 6-year event-free survival rates were 99.3 ± 0.7% in patients with normal coronary arteries, 96.7 ± 1.2% in patients with nonobstructive CAD, and 86.2 ± 3.0% in patients with obstructive CAD (log-rank p < 0.001).

Conclusions

Asymptomatic patients with type 2 diabetes mellitus with normal coronary arteries or nonobstructive CAD on coronary CTA show excellent clinical outcomes over a follow-up period of more than 5 years, whereas prognosis is worse in patients with obstructive CAD. These findings suggest long-term prognostic value of coronary CTA for asymptomatic type 2 diabetes mellitus.