Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography

Copyright © 2008 Society for Heart Attack Prevention and Eradication. All Rights Reserved.

CORONARY ARTERY DISEASE AMONG ASYMPTOMATIC

DIABETIC AND NONDIABETIC PATIENTS

UNDERGOING CORONARY CT ANGIOGRAPHY

Zeina AR, Blinder J, Rosenschein U, Zaid G , Barmeir E

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Zeina et al, Coronary Artery Disease 2008, 19:37–41Zeina et al, Coronary Artery Disease 2008, 19:37–41


• Coronary artery disease (CAD) is the major cause of death among patients

with diabetes. However, the true prevalence of CAD in asymptomatic

diabetic patients remains unknown

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• Diabetic patients, particularly those with other risk factors, are

usually treated aggressively without differentiation based on the presence

or absence of identifiable CAD


Introduction


• Only a few non-invasive studies using stress SPECT imaging in

asymptomatic diabetics have been reported. By providing no information

regarding coronary artery wall and lumen, this technique can reveal only

positive test results and not the true prevalence of anatomic CAD

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Introduction

http://www.fac.org.ar/scvc/llave/image/machac/machf3a.jpg


The aim of this study was to determine the prevalence and severity of

CAD and the plaque composition in asymptomatic diabetic patients

undergoing coronary CT angiography (CCTA)

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Purpose



- The study population consisted of 328328 consecutive patients (254 men,

mean age 56 ± 8 years) who presented to the outpatient clinic and were

referred for further evaluation of suspected CAD: 4242 diabetics and 286286

non-diabetics

- All participants were asymptomatic for cardiac-related symptoms before

the examination

- Each participant had at least one risk factor for CAD (diabetes mellitus,

hypertension, hyperlipidemia, smoking history, or family history of

symptomatic CAD) or abnormal stress-test results

Materials and Methods

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Table 1. Baseline characteristics of diabetic and non-diabetic patients.

Diabetic patients Non-diabetic patients

P value

(N= 42) (N= 286)

Age (years ± SD) 58 ± 8 56 ± 9 0.10

Male gender, n (%) 38 (90) 213 (74) 0.17

Family history, n (%) 14 (33) 126 (44) 0.19

Hypertension, n (%) 25 (59) 138 (48) 0.17

Hyperlipidemia, n (%)

19 (45) 152 (53) 0.34

Smoking, n (%) 15 (36) 101 (35) 0.96

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- CAD was defined as coronary atherosclerosis, with obstructive or non-

obstructive lesions

- CCTA was performed using two different MDCT scanners, the Lightspeed

16 Pro and VCT (General Electric Medical Systems, Milwaukee, WI)

- Findings were compared between patients with diabetes and those without

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Materials and Methods



The total Agatston score was significantly higher in diabetics versus non-

diabetics (370 ± 96 and 79.9 ± 16, respectively; P < 0.0001)

CAD was present in 39 (93%93%) diabetics and in 211211 (7373%) non-diabetics

(P = 0.006)

Obstructive CAD was more common in diabetics than in non-diabetics (29%

vs. 6.6% respectively; P < 0.0001)

In diabetics, more coronary segments with atherosclerosis per patient were

detected (5.5 segments/patient vs. 2.8 segments/patient in non-diabetics;

P < 0.0001) _______________________________________________________________________________

Results



Table 2. CCTA characteristics of the study population and comparison between diabetic and non-diabetic patients.

Diabetic patients

Non-diabetic patients

P value*

(n= 42) (n= 286)

Total Agatston score

370 ± 96 79.9 ± 16 < 0.0001

Coronary plaques 39 (93%) 211 (74%) 0.006

Obstructive CAD 12 (29%) 19 (6.6%) < 0.0001

Non-obstructive CAD

27 (64%) 141 (49%) 0.07

Segments with plaques/patient

5.5 2.8 < 0.0001

One-vessel disease 10 (24%) 16 (5.6%) < 0.0001

Two-vessel disease 1 (2%) 2 (0.7%) 0.3

Three-vessel disease

1 (2%) 1 (0.3%) 0.1

*P value < 0.05 is considered significant. CCTA= coronary CT angiography_______________________________________________________________________________

Results



54-year-old asymptomatic diabetic patient

MIPMIP 3D-VR3D-VR

CCTA



Discussion

Using the same diagnostic modality, such high prevalence

of CAD in asymptomatic diabetics has also been recently

reported (Scholte et al,Scholte et al, Heart 2007)

Our findings are in keeping with those of autopsy studies

identifying a high prevalence of coronary atherosclerosis in

patients with diabetes, even among those without clinical

CAD (Goraya et alGoraya et al, J Am Coll Cardiol 2002)

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Our results indicate a high prevalence (93%) of CAD in

asymptomatic diabetics with either non-obstructive or

obstructive lesions

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Conclusion

CCTA may be a useful imaging modality for selecting patients at

high risk who would benefit most from further evaluation for subclinical ischemia


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Coronary artery disease among asymptomatic diabetic and non-diabetic patients undergoing coronary CT angiography