Simon Deseive1, Ramona Straub2, Maximilian Kupke2, Alexander Broersen3, Pieter H Kitslaar4, Thomas J Stocker5, Steffen Massberg5, Martin Hadamitzky6, Jörg Hausleiter5. 1. Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany; Munich Heart Alliance at DZHK, Munich, Germany. Electronic address: simon.deseive@med.uni-muenchen.de. 2. Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany. 3. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands. 4. Division of Image Processing, Department of Radiology, Leiden University Medical Center, Leiden, the Netherlands; Medis Medical Imaging Systems bv, Leiden, the Netherlands. 5. Medizinische Klinik und Poliklinik I der Ludwig-Maximilians-Universität München, Munich, Germany; Munich Heart Alliance at DZHK, Munich, Germany. 6. Division of Radiology, Deutsches Herzzentrum München, Munich, Germany.
Abstract
BACKGROUND: To investigate the impact of diabetes on coronary artery total plaque volume (TPV) and adverse events in long-term follow-up. METHODS: One-hundred-and-eight diabetic patients were matched to 324 non-diabetic patients, with respect to age, sex, body-mass index, hypertension, smoking habits, LDL and HDL cholesterol, family history for CAD as well as aspirin and statin medication. In all patients, TPV was quantified from coronary CT angiographies (CTA) using dedicated software. All-cause mortality, acute coronary syndrome and late revascularisation (>90 days) served as combined endpoint. RESULTS: Patients were followed for 5.6 years. The endpoint occurred in 18 (16.7%) diabetic and 26 (8.0%) non-diabetic patients (odds ratio 2.3, p = 0.03). Diabetic patients had significantly higher TPV than non-diabetic patients (55.1 mm³ [IQR: 6.2 and 220.4 mm³] vs. 24.9 mm³ [IQR: 0 and 166.7 mm³], p = 0.02). A TPV threshold of 110.5 mm³ provided good separation of diabetic and non-diabetic patients at higher and lower risk for adverse events. Noteworthy, diabetic and non-diabetic patients with a TPV<110.5 mm³ had comparable outcome (hazard ratio: 1.3, p = 0.59), while diabetic patients with TPV>110.5 mm³ had significantly higher incidence of adverse events (hazard ratio 2.3, p = 0.03) compared to non-diabetic patients with TPV>110.5 mm³. There was incremental prognostic value in diabetic and non-diabetic patients over the Framingham Risk Score (Integrated Discrimination Improvement: 0.052 and 0.012, p for both <0.05). CONCLUSION: Diabetes is associated with significantly higher TPV, which is independent of other CAD risk factors. Quantification of TPV improves the identification of diabetic patients at higher risk for future adverse events.
BACKGROUND: To investigate the impact of diabetes on coronary artery total plaque volume (TPV) and adverse events in long-term follow-up. METHODS: One-hundred-and-eight diabeticpatients were matched to 324 non-diabeticpatients, with respect to age, sex, body-mass index, hypertension, smoking habits, LDL and HDL cholesterol, family history for CAD as well as aspirin and statin medication. In all patients, TPV was quantified from coronary CT angiographies (CTA) using dedicated software. All-cause mortality, acute coronary syndrome and late revascularisation (>90 days) served as combined endpoint. RESULTS:Patients were followed for 5.6 years. The endpoint occurred in 18 (16.7%) diabetic and 26 (8.0%) non-diabeticpatients (odds ratio 2.3, p = 0.03). Diabeticpatients had significantly higher TPV than non-diabeticpatients (55.1 mm³ [IQR: 6.2 and 220.4 mm³] vs. 24.9 mm³ [IQR: 0 and 166.7 mm³], p = 0.02). A TPV threshold of 110.5 mm³ provided good separation of diabetic and non-diabeticpatients at higher and lower risk for adverse events. Noteworthy, diabetic and non-diabeticpatients with a TPV<110.5 mm³ had comparable outcome (hazard ratio: 1.3, p = 0.59), while diabeticpatients with TPV>110.5 mm³ had significantly higher incidence of adverse events (hazard ratio 2.3, p = 0.03) compared to non-diabeticpatients with TPV>110.5 mm³. There was incremental prognostic value in diabetic and non-diabeticpatients over the Framingham Risk Score (Integrated Discrimination Improvement: 0.052 and 0.012, p for both <0.05). CONCLUSION:Diabetes is associated with significantly higher TPV, which is independent of other CAD risk factors. Quantification of TPV improves the identification of diabeticpatients at higher risk for future adverse events.