What is the clinical evidence from this study?

Study design: Observational. Population: Asymptomatic type 2 diabetes mellitus (n=215). Intervention: Coronary computed tomography angiography (CCTA) vs. Non-diabetic patients without coronary heart disease. Primary outcome: Obstructive stenosis (moderate-risk DM vs control) (OR 7.233, 95% CI 3.112-16.812, p=<0.001).

August 9, 2022Open Access

Coronary computed tomography angiography as a screening tool for moderate-high risk asymptomatic type 2 diabetes mellitus patients

Q: What are the key findings of this study?

Moderate-risk asymptomatic type 2 diabetes mellitus patients had significantly increased odds of obstructive coronary artery stenosis compared to non-diabetic controls (OR 7.233).

Key Result

Moderate-risk asymptomatic type 2 diabetes mellitus patients had significantly increased odds of obstructive coronary artery stenosis compared to non-diabetic controls (OR 7.233).

Study Design

Type

Observational (n=215)

Multicenter

Structured PICO

Does CCTA screening identify increased coronary plaque burden and obstructive stenosis in asymptomatic moderate-high risk T2DM patients compared to non-diabetic controls?

Population

215 patients, comprising 141 asymptomatic patients with type 2 diabetes mellitus (T2DM) without known symptoms suggestive of CHD (mean age 58 ± 8 years, 57% males) and 74 control patients without diabetes mellitus and CHD.

Intervention

Coronary computed tomography angiography (CCTA) with UKPDS CHD risk stratification

Comparator

Control group of patients without diabetes mellitus and CHD who underwent CCTA

Outcome

Coronary plaque burden and stenosis severity assessed by segment involvement score (SIS), segment stenosis score (SSS), stenosis coefficient (SC), severe proximal plaque (SPP) positive ratio, and CCTA-adapted Leaman score (CT-LeSc)surrogate

CCTA effectively identifies extensive and severe coronary artery stenosis in asymptomatic moderate-high risk T2DM patients, suggesting its utility as a screening tool in this population.

Main Result

Effect estimate: OR 7.233 (95% CI 3.112-16.812)

p-value: p=<0.001

Limitations

Single center retrospective study with potential selection bias
Did not systematically correlate CCTA results with invasive coronary angiography reference standards
UKPDS risk engine overlooks other cardiovascular risk factors such as chronic renal disease and peripheral artery disease
Potential difference between UKPDS predicted risk and actual risk in asymptomatic T2DM patients

Abstract

Background There are few data on the clinical significance of coronary computed tomography angiography (CCTA) in asymptomatic type 2 diabetes mellitus (T2DM) patients. We performed a retrospective study to evaluate coronary heart disease (CHD) screening in asymptomatic patients with T2DM using CCTA and CHD risk stratification prediction. Materials and methods Data from 141 T2DM patients (58 ± 8 years, 57% males) without known symptoms suggestive of CHD who underwent CCTA were retrospectively analyzed. The patients were classified into three subgroups based on United Kingdom prospective diabetes study (UKPDS) CHD risk stratification prediction. Seventy-four patients without diabetes mellitus and CHD who underwent CCTA successively were chosen as the control group. The segment involvement score (SIS), segment stenosis score (SSS), stenosis coefficient (SC), severe proximal plaque (SPP) positive ratio and CCTA-adapted Leaman score (CT-LeSc) based on CCTA data were evaluated and compared among the groups. Results Compared with the patients in the control group, patients in the moderate-high risk DM groups had higher scores on the SIS, SSS, SC, CT-LeSc, and a higher SPP positive ratio (all p -values 0.001), and no difference was observed between the low-risk group and the control group ( p = 0.136, p = 0.088, p = 0.0.067, p = 0.225, p = 1.000, respectively). Compared with patients in the control group, the patients in the moderate-high risk DM groups had increased odds of SIS 3 odds ratio (OR) = 6.557, p 0.001; OR = 4.455, p 0.001, respectively, SSS 5 (OR = 5.727, p 0.001; OR = 5.144, p 0.001, respectively), CT-LeSc 8.7 (OR = 3.780, p = 0.001; OR = 2.804, p = 0.007, respectively), and obstructive stenosis (OR = 7.233, p 0.001; OR = 5.787, p 0.001, respectively). Conclusion The moderate-high CHD risk patients had increased odds of obstructive coronary artery stenosis, and the distribution of coronary artery stenosis was more extensive and more severe in that group compared to the patients without diabetes mellitus and CHD. CHD can be effectively screened in moderate-high risk asymptomatic T2DM patients using CCTA.

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