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

Written By : Dr Riya Dave |Medically Reviewed By : Dr. Kamal Kant Kohli Published On 2023-09-30T10:00:17+05:30 | Updated On 30 Sept 2023 4:04 PM IST

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

Diabetes Care Journalcardiac computed tomographyInvasive coronary angiographyStable chest painDiabetes riskcardiovascular deathmyocardial infarction

Source : Diabetes Care Journal

Dr Riya Dave

Dr Riya Dave has completed dentistry from Gujarat University in 2022. She is a dentist and accomplished medical and scientific writer known for her commitment to bridging the gap between clinical expertise and accessible healthcare information. She has been actively involved in writing blogs related to health and wellness.

Dr. Kamal Kant Kohli

Dr Kamal Kant Kohli-MBBS, DTCD- a chest specialist with more than 30 years of practice and a flair for writing clinical articles, Dr Kamal Kant Kohli joined Medical Dialogues as a Chief Editor of Medical News. Besides writing articles, as an editor, he proofreads and verifies all the medical content published on Medical Dialogues including those coming from journals, studies,medical conferences,guidelines etc. Email: drkohli@medicaldialogues.in. Contact no. 011-43720751