Cardiac CT as First-line diagnostic Strategy in Diabetic Patients with Chest Pain

Usually patients are subjected to invasive  coronary angiography for diagnosis of myocardial infarction in patients  presenting with chest pain.

According to a recent study, Patients with diabetes who underwent cardiac computed tomography (CT) for stable chest pain showed no difference in major adverse cardiac events (MACE) compared to those who had invasive coronary angiography (ICA). Thus cardiac CT may be adopted as first line diagnostic strategy for stable chest patients in patients with  diabetes.

This study conducted by Theodora Benedek and colleagues has been published in Diabetes Care.

This multicenter study, conducted across 16 European countries, examined individuals with stable chest pain and an intermediate pretest probability of coronary artery disease. The primary endpoint was MACE, which includes cardiovascular death, nonfatal myocardial infarction, or stroke, while the secondary endpoint included expanded MACE, encompassing transient ischemic attacks and major procedure-related complications.

The key findings of the study were:

• After a median follow-up of 3.5 years, researchers assessed 3,541 patients, including 557 with diabetes.
• The results showed no significant difference in MACE rates between the CT group (263 patients) and the ICA group (294 patients) for both those with and without diabetes.
• However, among diabetic patients, the CT-first strategy exhibited a lower rate of expanded MACE (3.8% vs. 8.2%) and major procedure-related complications (0.4% vs. 2.7%) compared to the ICA-first strategy.

In summary, for individuals with diabetes referred for coronary artery investigations due to stable chest pain, initiating the diagnostic process with a CT scan rather than ICA did not increase the risk of MACE and may potentially reduce the incidence of expanded MACE and major procedure-related complications.

Reference:

Benedek, T., Wieske, V., Szilveszter, B., Kofoed, K. F., Donnelly, P., Rodriguez-Palomares, J., Erglis, A., Veselka, J., Šakalytė, G., Ađić, N. Č., Gutberlet, M., Diez, I., Davis, G., Zimmermann, E., Kępka, C., Vidakovic, R., Francone, M., Ilnicka-Suckiel, M., Plank, F., … Dewey, M. Computed tomography versus invasive coronary angiography in patients with diabetes and suspected coronary artery disease. Diabetes Care,2023 dc230710. https://doi.org/10.2337/dc23-0710