Key result
Atherosclerotic extent (Leiden score ≥5) was associated with an increased risk of MACE compared to a score <5 in diabetic patients with nonobstructive CAD (HR 1.88; 95% CI 1.03-3.42; p=0.039).
Why the study?
The ability of CCTA-derived risk scores to identify high-risk patients with nonobstructive CAD remains uncertain in the presence of diabetes mellitus.
Does a higher atherosclerotic extent (Leiden score ≥ 5) on CCTA predict an increased risk of MACE in diabetic patients with nonobstructive CAD?
Cohort (n=813)
Does a higher atherosclerotic extent (Leiden score ≥ 5) on CCTA predict an increased risk of MACE in diabetic patients with nonobstructive CAD?
Hazard Ratio: 1.88 (95% CI 1.03–3.42)
p-value: p=0.039
In diabetic patients with nonobstructive CAD, a higher atherosclerotic extent (Leiden score ≥ 5) on CCTA is independently associated with an increased risk of major adverse cardiovascular events.
May refine prognosis in diabetic nonobstructive CAD; hypothesis-generating for targeted interventions.
Background and Objective. Atherosclerotic extent was proved to be associated with adverse cardiac events. Risk scores derived by coronary computed tomography angiography (CCTA) could identify high-risk group among patients with nonobstructive coronary artery disease (CAD), but the ability is still uncertain in the presence of diabetes mellitus (DM). The purpose of this study was to investigate the prognostic value of the atherosclerotic extent shown by CCTA in diabetic patients with nonobstructive CAD. Methods and Results. 813 DM patients (mean age <a:math xmlns:a="http://www.w3.org/1998/Math/MathML" id="M1"> <a:mn>58.9</a:mn> <a:mo>±</a:mo> <a:mn>9.9</a:mn> </a:math> years, 48.1% male) referred for CCTA due to suspected CAD in 2015-2017 were consecutively included. During a median follow-up of 31.77 months, 50 major adverse cardiovascular events (MACEs) (6.15%) were experienced, including 2 cardiovascular deaths, 14 nonfatal myocardial infarctions, 27 unstable anginas requiring hospitalization, and 7 strokes. Three groups were defined based on coronary stenosis combined with Leiden score as normal, nonobstructive <c:math xmlns:c="http://www.w3.org/1998/Math/MathML" id="M2"> <c:mtext>Leiden</c:mtext> <c:mo><</c:mo> <c:mn>5</c:mn> </c:math> , and nonobstructive <e:math xmlns:e="http://www.w3.org/1998/Math/MathML" id="M3"> <e:mtext>Leiden</e:mtext> <e:mo>≥</e:mo> <e:mn>5</e:mn> </e:math> . Cox models were used to assess the prognosis of plaque burden within these groups. An incremental incidence of MACE rates was observed. After adjustment for age, gender, and presence of high-risk plaque, the group of <g:math xmlns:g="http://www.w3.org/1998/Math/MathML" id="M4"> <g:mtext>Leiden</g:mtext> <g:mo>≥</g:mo> <g:mn>5</g:mn> </g:math> showed a higher risk than <i:math xmlns:i="http://www.w3.org/1998/Math/MathML" id="M5"> <i:mtext>Leiden</i:mtext> <i:mo><</i:mo> <i:mn>5</i:mn> </i:math> (HR: 1.88, 95% CI: 1.03-3.42, <k:math xmlns:k="http://www.w3.org/1998/Math/MathML" id="M6"> <k:mi>p</k:mi> <k:mo>=</k:mo> <k:mn>0.039</k:mn> </k:math> ). Similar results were observed when segment involvement score (SIS) was used for sensitivity analysis. Conclusion. Atherosclerotic extent was associated with the prognosis of DM patients with nonobstructive coronary artery disease, highlighting the importance of better risk stratification and management.
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Ding et al. (2021) conducted a cohort in diabetic patients with nonobstructive CAD (n=813). Atherosclerotic extent (Leiden score ≥5) vs. Leiden score <5 was evaluated on major adverse cardiovascular events (MACEs) (HR 1.88, 95% CI 1.03-3.42, p=0.039). Atherosclerotic extent (Leiden score ≥5) was associated with an increased risk of MACE compared to a score <5 in diabetic patients with nonobstructive CAD (HR 1.88; 95% CI 1.03-3.42; p=0.039).
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