Key result
In diabetic patients with non-obstructive coronary artery disease, a Segment Involvement Score ≥ 3 was associated with a higher risk of major adverse cardiac events compared to a score < 3 (HR 2.02).
Why the study?
Whether atherosclerotic extent is related to prognosis in non-obstructive coronary artery disease was uncertain, particularly in patients with diabetes.
Does higher atherosclerotic extent on CCTA predict increased risk of major adverse cardiac events in diabetic patients with non-obstructive CAD?
Cohort (n=1,241)
No
Does higher atherosclerotic extent on CCTA predict increased risk of major adverse cardiac events in diabetic patients with non-obstructive CAD?
Hazard Ratio: 2.02 (95% CI 1.11–3.68)
Absolute Event Rate: 12.3% vs 5.5%
p-value: p=0.021
In diabetic patients with non-obstructive CAD, a higher atherosclerotic extent on CCTA is independently associated with an increased risk of long-term major adverse cardiac events.
May support CCTA-based risk stratification in diabetic non-obstructive CAD; hypothesis-generating and should not yet change practice.
Background: The prognostic value of non-obstructive CAD has always been underestimated due to its moderate stenosis. Whether the atherosclerotic extent is related to the prognosis in this group of people is uncertain, especially in the presence of diabetes. We aim to investigate the prognostic value of atherosclerotic extent in diabetic patients with non-obstructive coronary artery disease (CAD). Method: The analysis was based on a single center cohort of diabetic patients referred for coronary computed tomography angiography (CCTA) due to suspect CAD. Major adverse cardiac events (MACEs) were recorded, including cardiovascular death, non-fatal myocardial infarction, stroke and unstable angina (UA) requiring hospitalization. Four groups were defined based on coronary stenosis combined with segment involvement score (SIS), a semiquantitative index of the extent of atherosclerosis, including normal, non-obstructive SIS<3, non-obstructive SIS≥3 and obstructive. Time to event was estimated by using multivariable Cox proportional hazards models. Leidon risk score was used to replace SIS for sensitivity analysis. Results: In total, 1241 patients were included (age 60.2±10.4 years, 54.1% male), experiencing 131 MACEs (10.6%) during a median follow-up of 2.6 years. Diabetic patients with non-obstructive CAD accounts for 50.2% of included population（N=623）. In multi-variate Cox model adjusting for age, gender, hyperlipidemia and presence of high-risk plaque, hazard ratio (HR) for SIS < 3 and SIS ≥ 3 in non-obstructive CAD were 1.84 (95%CI: 0.70-4.79) and 3.71 (95%CI: 1.37-10.00) respectively.The latter showed a higher risk of cardiac adverse events than the former group（HR：2.02 95%CI:1.11-3.68, p＝0.021）, while HR for obstructive CAD was 5.46 (95%CI: 2.18-13.69). Sensitivity analysis was performed using Leidon Risk Score instead of SIS. After adjustment, HR for Leidon ≥ 5 with non-obstructive disease was 1.92（95% CI: 1.06-3.48 p=0.032）in comparison to the non-obstructive group of Leidon < 5. Conclusion: In diabetic patients with non-obstructive CAD, atherosclerotic extent was associated with higher risk of major adverse cardiac events at long-term follow-up. Efforts should be made to determine risk stratification for the management of DM patients with non-obstructive CAD.
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Liu et al. (2020) conducted a cohort in Suspected coronary artery disease in diabetes mellitus (n=1,241). Non-obstructive CAD with Segment Involvement Score ≥ 3 vs. Non-obstructive CAD with Segment Involvement Score < 3 was evaluated on Major adverse cardiac events (MACEs) (HR 2.02, 95% CI 1.11-3.68, p=0.021). In diabetic patients with non-obstructive coronary artery disease, a Segment Involvement Score ≥ 3 was associated with a higher risk of major adverse cardiac events compared to a score < 3 (HR 2.02).
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