Plaque assessment by coronary CT angiography may predict cardiac events in high risk and very high risk diabetic patients: A long-term follow-up study

• DOI: 10.1016/j.numecd.2021.11.013
• Publication Date: 2021-12-13T16:17:54Z
• Authors: Daniele Andreini; Edoardo Conte; Saima Mushtaq; Marco Magatelli; Federica Traversari; Carlo Gigante; Marta Belmonte; Marcherita Gauden...; Andrea Annoni; Alberto Formenti; Maria E. Mancini; Marco Guglielmo; Andrea Baggiano; Eleonora Melotti; Giuseppe Muscogiuri; Maurizio Rondinelli; Gianluca Pontone; Antonio L. Bartor...; Mauro Pepi; Stefano Genovese
• Keywords: Cardiac CT; Coronary artery disease; Diabetes; Prognosis; Vulnerable coronary plaque; Computed Tomography Angiography; Coronary Artery Disease; Coronary Angiography; Prognosis; Risk Assessment; Plaque, Atherosclerotic; Cardiac CT; Coronary artery disease; Diabetes; Prognosis; Vulnerable coronary plaque;; 3. Good health; 03 medical and health sciences; 0302 clinical medicine; Predictive Value of Tests; Risk Factors; Diabetes Mellitus; Humans; Follow-Up Studies

The aim of the present study is to evaluate whether advanced coronary atherosclerosis analysis by CCTA may improve prognostic stratification among diabetic patients at high cardiovascular risk (CV risk).The study population consisted of 265 consecutive diabetic patients at high CV risk who underwent CCTA for suspected CAD between January 2011 and December 2016. For every patients both traditional and advanced, qualitative and quantitative coronary plaque analysis were performed. The occurrence of cardiac death, ACS, and non-urgent revascularization were recorded at follow-up. Among the 265 patients enrolled, 21 were lost to follow-up, whereas 244 (92%) had a complete follow-up (mean 45 ± 22 months) and were classified at high (n = 67) or very high cardiovascular risk (n = 177), according to ESC Guidelines. A total of 63 events were recorded (3 Cardiac Death, 3 NSTEMI, 8 unstable angina, 36 late non-urgent revascularization and 13 non-cardiac death) in 57 different patients. Elevated fibro-fatty plaque volume was the only predictor of events over age, gender and traditional risk factor when ACS and MACE were considered as end-points [HR (95% CI) 6.01 (1.65-21.87), p = 0.006 and 3.46 (2.00-5.97); p < 0.001].The present study confirms the prognostic role of advance coronary atherosclerosis evaluation beyond risk factors and stenosis severity, even in diabetics. Despite the very high cardiovascular risk of study population, a not negligible portion (23%) of patients exhibited totally normal coronaries.