CCTA derived plaque data improves risk assessment of heart disease in diabetes patients: Study
Germany: Coronary CT angiography (CCTA) derived plaque information may improve heart disease risk assessment in diabetes patients compared with assessment of obstructive stenosis on CCTA alone, a recent study has found. The results, published in the Journal of Thoracic Imaging, portend improved risk stratification in both patients with and without diabetes.
Diabetes is associated with a significantly higher extent of coronary artery disease and plaque features, which have independent predictive values for MACE. Christian Tesche, Department of Cardiology, Munich University Clinic, Ludwig-Maximilians-University, and colleagues aimed to investigate the long-term prognostic value of coronary computed tomography angiography (cCTA)-derived plaque information on major adverse cardiac events (MACE) in patients with and without diabetes mellitus.
The study included 64 patients with diabetes (63.3±10.1 y, 66% male) and suspected coronary artery disease who underwent cCTA matched with 297 patients without diabetes according to age, sex, cardiovascular risk factors, and statin and antithrombotic therapy.
MACE was recorded. CCTA-derived risk scores and plaque measures were assessed. The discriminatory power to identify MACE was evaluated.
The study yielded the following findings:
- After a median follow-up of 5.4 years, MACE occurred in 31 patients (8.6%).
- In patients with diabetes, cCTA risk scores and plaque measures were significantly higher compared with nondiabetic patients.
- The following plaque measures were predictors of MACE using multivariable Cox regression analysis (hazard ratio [HR]) in patients with diabetes: segment stenosis score (HR=1.20), low-attenuation plaque (HR=3.47), and in nondiabetic patients: segment stenosis score (HR=1.92), Agatston score (HR=1.0009), and low-attenuation plaque (HR=4.15).
- A multivariable model showed a significantly improved C-index of 0.96 for MACE prediction, when compared with single measures alone.
"cCTA-derived plaque information portends improved risk stratification of patients with diabetes beyond the assessment of obstructive stenosis on cCTA alone with subsequent impact on individualized treatment decision-making, the author summed up.
Tesche, Christian MD*,†,‡,§; Baquet, Moritz MD*; Bauer, Maximilian J. MD†,§; Straube, Florian MD†; Hartl, Stefan MD∥; Leonard, Tyler BSc§; Jochheim, David MD*; Fink, David Med†; Brandt, Verena MD§,¶; Baumann, Stefan MD§,#; Schoepf, U. Joseph MD§,**; Massberg, Steffen MD*; Hoffmann, Ellen MD†; Ebersberger, Ullrich MD*,†,§,†† Prognostic Utility of Coronary Computed Tomography Angiography-derived Plaque Information on Long-term Outcome in Patients With and Without Diabetes Mellitus, Journal of Thoracic Imaging: October 28, 2021 - Volume - Issue - doi: 10.1097/RTI.0000000000000626